Powla Plamena P
Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, IN, USA.
Neurocrit Care. 2025 Apr 14. doi: 10.1007/s12028-025-02271-8.
Traumatic brain injury (TBI) is a significant global health issue, yet its impact is disproportionately borne by low-income and middle-income countries (LMICs), where higher exposure to risk factors and limited health care resources exacerbate the burden. Despite this, the majority of TBI research is derived from data sets curated in high-income countries (HICs), where research infrastructure and resources are more extensive. As a result, clinical guidelines for TBI management are primarily shaped by data from HICs, with little consideration for the distinct factors and health care challenges in resource-limited settings. This gap hinders the development of effective TBI management guidelines for LMICs, where unique circumstances and challenges such as injury mechanisms, prehospital care, comorbidities, and hospital resources must be considered. Nonetheless, HICs have the resources and infrastructure to collect data on variables that may not be as urgent in their own settings but are critical for understanding challenges in LMICs. Integrating these globally applicable variables into data sets from HICs is essential for facilitating more relevant cross-contextual comparisons and improving care in LMICs. Bridging this gap requires equitable collaboration with LMIC researchers to ensure their perspectives are prioritized and that research efforts contribute to the development of truly representative data sets. By fostering such collaborations, the global community can work toward evidence-based guidelines that reflect the diverse realities of TBI care, ultimately improving outcomes for patients worldwide.
创伤性脑损伤(TBI)是一个重大的全球健康问题,但其影响在低收入和中等收入国家(LMICs)中承受的比例过高,在这些国家,更高的风险因素暴露和有限的医疗资源加剧了负担。尽管如此,大多数TBI研究来自高收入国家(HICs)整理的数据集,这些国家的研究基础设施和资源更为广泛。因此,TBI管理的临床指南主要由HICs的数据塑造,很少考虑资源有限环境中的独特因素和医疗挑战。这种差距阻碍了为LMICs制定有效的TBI管理指南,在这些国家,必须考虑诸如损伤机制、院前护理、合并症和医院资源等独特情况和挑战。尽管如此,HICs拥有资源和基础设施来收集关于某些变量的数据,这些变量在其自身环境中可能不那么紧迫,但对于理解LMICs中的挑战至关重要。将这些全球适用的变量整合到HICs的数据集中,对于促进更相关的跨背景比较和改善LMICs的护理至关重要。弥合这一差距需要与LMICs的研究人员进行公平合作,以确保他们的观点得到优先考虑,并且研究工作有助于开发真正具有代表性的数据集。通过促进这种合作,全球社会可以朝着基于证据的指南努力,这些指南反映了TBI护理的不同现实,最终改善全球患者的治疗结果。