ESSENTIAL EQUITABLE TRAUMATIC BRAIN INJURY (TBI) CARE:
A Delphi Survey to Develop Essential Global Standards for TBI Care
Thank you for your interest in our Delphi study on Essential Neurotrauma Care!
Study Group: Halinder Mangat, Carl-Otto Schell, Tim Baker, Alexandra Wharton-Smith, and Liza Bokova.
The survey is coordinated by the University of Kansas, has ethical approval from the Kansas University Medical Center research Institute Review Board, and is supported by an intramural grant.
The Delphi Survey includes 3 sections, which will take an estimated 15 minutes to complete. Participants who complete all sections of the survey will be included in group authorship of the resulting Delphi study publication(s). The 3 sections include:
R0: Participant demographics, practice and contacts
R1: Tiered therapies from EECC: availability, use, barriers
R2: Tiered therapies from SIBICC protocol by healthcare facility type
BACKGROUND:
Evidence for the management of TBI patients is largely derived from well-resourced health systems. However, 90% of TBI occur in low-middle income countries (LMICs) with 4-fold higher mortality, and clinical care requires judicious use of limited resources to provide maximal benefit to patients most likely to benefit, often termed ‘fair allocation of scarce resources. Therefore, much of the recommendations which are derived from moderate and low-level evidence and form the backbone of evidence-based guidelines for the management of neurotrauma are neither pragmatic nor cost-effective to practice in resource-constrained environments.
Even within health systems, provisions of care vary between urban and rural settings, highly populated and sparsely populated areas, geographically isolated versus accessible areas, and between native and migrant populations. This diversity provides an imperative to make neurotrauma care equitable by maximizing health system efficiency. We therefore need to develop a conceptual framework of “Essential Neurotrauma” which is a consistent, high quality yet equitable standard of care for the provision of neurotrauma care worldwide to anyone hospitalized with a TBI, anywhere, anytime, along the chain of trauma care.
The “Essential” care framework was developed and envisaged in the “Essential Emergency and Critical Care” (EECC) concept developed by Schell et al, and provides a framework of lifesaving, vital organ supporting clinical care processes that should be provided to all critically ill patients in all hospitals worldwide. EECC has been adopted by the government of Tanzania as a spearheading nation and has hubs in Tanzania, Cameroon, Nigeria, Malawi, Rwanda, and Sweden. Furthermore, the World Health Assembly in May 2023, adopted a resolution on Integrative Emergency, Critical and Operative Care, which is exemplified in this study’s approach.