The Brain Trauma Foundation (BTF) Guidelines for the Management of Traumatic Brain Injury have been considered the gold standard document for evidence-based interventions in TBI care worldwide (1). Since their introduction in the late 90s, other international guidelines have been published with similar structure or just as an adaptation or adoption process (2–7).
Most of these guidelines have been developed in high income countries (HIC’s), were advanced technology for neuromonitoring is available. Unfortunately, some of these devices are not worldwide available and limits the application of some recommendations, including a barrier for defining thresholds for urgent decision making (8). This current situation creates a critical gap in knowledge transferability when it is required to adapt or develop local protocols, especially in low- and middle-income countries (LMIC´s) (Figure 1).
Guidelines and Protocols from HIC’s and LMIC’s
We present a summary of the main international HIC’s and LMIC’s guidelines in Table 1, including the link for their complete access (1-7) (9-11). Then, in Table 2 we describe Guidelines, Consensus and Protocols that has been developed with the aim of address the gaps in knowledge transferability for the management of TBI cases were not all the resources are available (12-15), including the recent BOOTStraP Consensus, that define stratified protocols for applying it according to the available resources and training level for near to 10 different scenarios for Prehospital (EMS), Emergency Room (ER), Intensive Care Unit (ICU) or Operation Room (OR) (Figure 2) (15).
Table 1. Main international guidelines from HIC’s and LMIC’s.
Table 2. International guidelines and protocols for specific situations in TBI patients
Traumatic brain injury management is a critical intervention for tackling one of the main diseases associated with the bigger burden of death and disability worldwide. Several guidelines, consensus and protocols have been proposed, mostly developed in HIC’s. Knowledge transferability barriers have been identified when applying international guidelines in LMIC´s. Recently some specific guidelines, consensus, and protocols, oriented for decision making in areas were not all the resources exists have been developed. The stratification of care according to the level of resources and training is opening a new era in consensus and protocol development for a global application.
References
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