Wooldridge Gavin, Hansmann Andreas, Aziz Omer, O'Brien Nicole
Queen Elizabeth Central Hospital, Blantyre, Malawi.
National Pediatric Hospital, Phnom Penh, Cambodia.
Childs Nerv Syst. 2020 Nov;36(11):2647-2655. doi: 10.1007/s00381-020-04603-9. Epub 2020 Apr 16.
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, with a disproportionately high burden in low-middle income countries. Guideline implementation has been associated with mortality reduction in high-income countries (HIC), but it is not known if hospitals in low and middle-income countries possess the resources to implement the pre-hospital TBI guidelines and the guidelines for the management of severe pediatric traumatic brain injury.
An anonymous online survey was undertaken by a range of health care professionals currently managing children with severe TBI in low to middle-income countries. A variety of international and national pediatric, intensive care, and neurological societies assisted in the survey distribution. Thirty-eight questions were included to evaluate patient care and the provider's perceptions of their resources available to implement the pre-hospital specific TBI and current pediatric severe TBI guidelines.
Two hundred and forty-seven hospitals were represented from 68 countries. Fifty percent of LMIC hospitals that responded had the resources to implement 13 of 15 guidelines for the pediatric component of pre-hospital management for TBI and all baseline care recommendations. First tier therapies including the intracranial pressure (ICP) and cerebral perfusion pathways (CPP), however, demonstrated low capacity for uptake with 21.5% and 38.5% of surveyed hospitals possessing sufficient resources to follow the recommended pathways.
Pediatric TBI ICP/CPP management guidelines require numerous resources not widely sourced in LMIC. The creation of international guidelines that outline recommendations of care for LMIC may benefit patient care and outcomes in these settings.
创伤性脑损伤（TBI）是全球死亡和残疾的主要原因，在低收入和中等收入国家负担尤其沉重。指南的实施与高收入国家（HIC）死亡率的降低相关，但尚不清楚低收入和中等收入国家的医院是否具备实施院前TBI指南和重度小儿创伤性脑损伤管理指南的资源。
一系列目前在低收入和中等收入国家管理重度TBI患儿的医疗保健专业人员进行了一项匿名在线调查。各种国际和国家的儿科、重症监护和神经学会协助进行了调查分发。调查包含38个问题，以评估患者护理情况以及提供者对其可用于实施院前特定TBI和当前小儿重度TBI指南的资源的看法。
来自68个国家的247家医院参与了调查。做出回应的低收入和中等收入国家医院中，50%有资源实施15项TBI院前管理儿科部分指南中的13项以及所有基线护理建议。然而，包括颅内压（ICP）和脑灌注途径（CPP）在内的一线治疗方法的采用能力较低，分别有21.5%和38.5%的受调查医院拥有足够资源遵循推荐途径。
儿科TBI的ICP/CPP管理指南需要大量资源，而这些资源在低收入和中等收入国家并不广泛可得。制定概述低收入和中等收入国家护理建议的国际指南可能会改善这些地区的患者护理和治疗结果。
