TY - JOUR
T1 - Protocol for a Multicenter, Prospective, Observational Pilot Study on the Implementation of Resource-Stratified Algorithms for the Treatment of Severe Traumatic Brain Injury Across Four Treatment Phases
T2 - Prehospital, Emergency Department, Neurosurgery, and Intensive Care Unit
AU - Griswold, Dylan P.
AU - Carney, Nancy
AU - Ballarini, Nicolas M.
AU - Fernandez, Laura L.
AU - Kolias, Angelos
AU - Hutchinson, Peter J.
AU - Rubiano, Andres M.
N1 - Publisher Copyright:
© The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons. This is an open access article distributed under the terms of the (Creative Commons Attribution Licence 4.0 (CC BY)), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - BACKGROUND: Severe traumatic brain injury (sTBI) is a public health issue with great disparity among low- and middle-income countries where the implementation of evidence-based guidelines is challenging because resources are often unavailable. A consensus process including experts in the prehospital, emergency department, neurosurgery, and intensive care unit took place in Colombia to develop a set of stratified protocols called BOOTStraP, targeting resource-poor environments, but it has not been systematically implemented and tested. OBJECTIVE: To identify the facilitators of, and barriers to, collecting data about patients with sTBI and to implement a stratified protocol across the treatment phases of prehospital, emergency department, neurosurgery, and intensive care unit in low-resource settings. We also aim to identify a possible association between adherence to these protocols and outcomes for these patients. METHODS: A prospective, observational, before and after, pilot study will be performed in three phases as follows: before implementation, implementation, and after implementation. The BOOTStraP protocols will be implemented in three Colombian centers. EXPECTED OUTCOMES: We expect to find numerous barriers during the implementation phase. We also expect moderate adherence to the protocols. However, we expect to find an increase in the survival rate to hospital discharge and an improvement in neurological outcomes at discharge. DISCUSSION: This pilot study will serve as a first step to identify variables that are critical to successful implementation, to be considered for the design of a future large-scale international study to measure the effectiveness of resource-based protocols and to improve outcomes from sTBI.
AB - BACKGROUND: Severe traumatic brain injury (sTBI) is a public health issue with great disparity among low- and middle-income countries where the implementation of evidence-based guidelines is challenging because resources are often unavailable. A consensus process including experts in the prehospital, emergency department, neurosurgery, and intensive care unit took place in Colombia to develop a set of stratified protocols called BOOTStraP, targeting resource-poor environments, but it has not been systematically implemented and tested. OBJECTIVE: To identify the facilitators of, and barriers to, collecting data about patients with sTBI and to implement a stratified protocol across the treatment phases of prehospital, emergency department, neurosurgery, and intensive care unit in low-resource settings. We also aim to identify a possible association between adherence to these protocols and outcomes for these patients. METHODS: A prospective, observational, before and after, pilot study will be performed in three phases as follows: before implementation, implementation, and after implementation. The BOOTStraP protocols will be implemented in three Colombian centers. EXPECTED OUTCOMES: We expect to find numerous barriers during the implementation phase. We also expect moderate adherence to the protocols. However, we expect to find an increase in the survival rate to hospital discharge and an improvement in neurological outcomes at discharge. DISCUSSION: This pilot study will serve as a first step to identify variables that are critical to successful implementation, to be considered for the design of a future large-scale international study to measure the effectiveness of resource-based protocols and to improve outcomes from sTBI.
KW - LMICs
KW - Neurotrauma
KW - Protocol
KW - Resource-stratified guidelines
KW - TBI
KW - Traumatic brain injury
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U2 - 10.1227/neu.0000000000002004
DO - 10.1227/neu.0000000000002004
M3 - Article
C2 - 35485862
AN - SCOPUS:85134428151
SN - 0148-396X
VL - 91
SP - 355
EP - 359
JO - Neurosurgery
JF - Neurosurgery
IS - 2
ER -