ABSTRACT

Importance

Severe traumatic brain injury (sTBI) is a critical health problem in regions of limited resources (RLRs). Younger populations are among the most impacted. The objective of this review is to analyze recent consensus-based algorithms, protocols and guidelines proposed for the care of patients with TBI in RLRs.

Observations

The principal mechanisms for sTBI in RLRs are road traffic injuries (RTIs) and violence. Limitations of care include suboptimal or non-existent pre-hospital care, overburdened emergency services, lack of trained human resources, and surgical and intensive care. Low-cost neuromonitoring systems are currently in testing, and formal neurotrauma registries are forming to evaluate both long-term outcomes and best practices at every level of care from hospital transport to the emergency department (ED), to the operating room and intensive care unit (ICU).

Conclusions and Relevance

The burden of sTBI is highest in RLRs. As working-age adults are the predominantly affected age-group, an increase in disability-adjusted life years (DALYs) generates a loss of economic growth in regions where economic growth is needed most. Four multi-institutional collaborations between high-income countries (HICs) and LMICs have developed evidence and consensus-based documents focused on capacity building for sTBI care as a means of addressing this substantial burden of disease.

中文翻译：

---

资源有限地区严重颅脑损伤的处理

摘要

重要性

严重创伤性脑损伤 (sTBI) 是资源有限 (RLR) 地区的一个严重健康问题。年轻人口受影响最大。本综述的目的是分析最近为 RLR 中 TBI 患者的护理提出的基于共识的算法、协议和指南。

观察

RLR 中 sTBI 的主要机制是道路交通伤害 (RTI) 和暴力。护理的局限性包括院前护理欠佳或不存在、急诊服务负担过重、缺乏训练有素的人力资源以及外科和重症监护。低成本神经监测系统目前正在测试中，并且正在形成正式的神经创伤登记处，以评估从医院运输到急诊室 (ED)、手术室和重症监护室的各个护理级别的长期结果和最佳实践（重症监护病房）。

结论和相关性

sTBI 的负担在 RLR 中最高。由于工作年龄的成年人是主要受影响的年龄组，因此在最需要经济增长的地区，伤残调整生命年 (DALYs) 的增加会导致经济增长的损失。高收入国家 (HIC) 和 LMIC 之间的四项多机构合作已经制定了基于证据和共识的文件，重点关注 sTBI 护理的能力建设，作为解决这一重大疾病负担的一种手段。