• World Neurosurg · Feb 2018

    Development of a Severe Traumatic Brain Injury Consensus-Based Treatment Protocol Conference in Latin America.

    • Peter Hendrickson, James Pridgeon, Nancy R Temkin, Walter Videtta, Gustavo Petroni, Silvia Lujan, Nahuel Guadagnoli, Zulma Urbina, Perla Blanca Pahnke, Daniel Godoy, Gustavo Pinero, Lora Freddy Sandi FS Hospital Obrero No 1 de La Paz, La Paz, Bolivia., Sergio Aguilera, Andres M Rubiano, Caridad Soler Morejon, Manuel Jibaja, Hubiel Lopez, Ricardo Romero, Sureyya Dikmen, Kelley Chaddock, and Randall M Chesnut.
    • Harborview Medical Center, University of Washington, Seattle, Washington, USA.
    • World Neurosurg. 2018 Feb 1; 110: e952-e957.

    BackgroundSevere traumatic brain injury (sTBI) is a significant global health problem disproportionately affecting low- and middle-income countries (LMICs). Management of intracranial hypertension in sTBI is crucial to survival and optimal recovery. Practitioners in high-income countries routinely use intracranial pressure (ICP) monitors although their usefulness has been questioned. ICP monitors are usually unavailable in LMICs. No consensus-based/tested protocols or literature exists for sTBI treatment without ICP monitoring.MethodsInvestigators developed serial SurveyMonkey surveys for Latin American neurointensivists and neurosurgeons to determine current practice. These clinicians had extensive routine ongoing experience in sTBI without ICP monitoring. Surveys were administered and analyzed before/during/after a 2015 Buenos Aires consensus conference. Investigators identified areas of convergence blinded from colleagues' responses. A 47-clinician task force, representing 15 countries, who routinely manage patients with sTBI without monitors developed consensus-based treatment guidelines during a 3-day facilitated conference.ResultsElements were added to the protocol at an 80% agreement threshold. Follow-on surveys resolved remaining elements to 97% agreement. The protocol addresses both tapering (on improvement) and neuroworsening. Staged treatment options were identified, plus unique clinical practice issues. This process introduced a research method to a large multidisciplinary group of LMIC clinicians. This report describes the process used to develop an LMIC-specific protocol that is transferable to other diseases/injuries. The protocol is being tested in 5 LMICs.ConclusionsWe derived consensus-based guidelines for sTBI treatment without ICP monitoring, and introduced a research method to a large multidisciplinary group of LMIC clinicians naive to such methods.Copyright © 2017 Elsevier Inc. All rights reserved.

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