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. 2018 Feb:110:e952-e957.
doi: 10.1016/j.wneu.2017.11.142. Epub 2017 Dec 5.

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

Peter Hendrickson  1 , James Pridgeon  1 , Nancy R Temkin  1 , Walter Videtta  2 , Gustavo Petroni  3 , Silvia Lujan  3 , Nahuel Guadagnoli  4 , Zulma Urbina  5 , Perla Blanca Pahnke  6 , Daniel Godoy  7 , Gustavo Pinero  8 , Freddy Sandi Lora  9 , Sergio Aguilera  10 , Andres M Rubiano  11 , Caridad Soler Morejon  12 , Manuel Jibaja  13 , Hubiel Lopez  14 , Ricardo Romero  15 , Sureyya Dikmen  1 , Kelley Chaddock  1 , Randall M Chesnut  16
Affiliations

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

Peter Hendrickson et al. World Neurosurg. 2018 Feb.

Abstract

Background: Severe 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.

Methods: Investigators 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.

Results: Elements 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.

Conclusions: We 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.

Keywords: Consensus treatment protocol; Global health; Intracranial hypertension; Intracranial pressure monitoring; Neurocritical care; Severe traumatic brain injury.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

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