Managing Severe Traumatic Brain Injury Across Resource Settings: Latin American Perspectives

Ronald Alvarado-Dyer, Sergio Aguilera, Randall M. Chesnut, Walter Videtta, Danilo Fischer, Manuel Jibaja, Daniel A. Godoy, Roxanna M. Garcia, Fernando D. Goldenberg, Christos Lazaridis

Producción científica: Contribución a una revistaArtículorevisión exhaustiva

1 Cita (Scopus)


Severe traumatic brain injury (sTBI) is a condition of increasing epidemiologic concern worldwide. Outcomes are worse as observed in low- and middle-income countries (LMICs) versus high-income countries. Global targets are in place to address the surgical burden of disease. At the same time, most of the published literature and evidence on the clinical approach to sTBI comes from wealthy areas with an abundance of resources. The available paradigms, including the Brain Trauma Foundation guidelines, the Seattle International Severe Traumatic Brain Injury Consensus Conference, Consensus Revised Imaging and Clinical Examination, and multimodality approaches, may fit differently depending on local resources, expertise, and sociocultural factors. A first step toward addressing heterogeneity in practice is to consider comparative effectiveness approaches that can capture actual practice patterns and record short-term and long-term outcomes of interest. Decompressive craniectomy (DC) decreases intracranial pressure burden and can be lifesaving. Nevertheless, completed randomized controlled trials took place within high-income settings, leaving important questions unanswered and making extrapolations to LMICs questionable. The concept of preemptive DC specifically to address limited neuromonitoring resources may warrant further study to establish a benefit/risk profile for the procedure and its role within local protocols of care.

Idioma originalInglés
Páginas (desde-hasta)229-234
Número de páginas6
PublicaciónNeurocritical Care
EstadoPublicada - 12 ene. 2023


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