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. 2020 Jan;11(1):7-22.
doi: 10.1055/s-0040-1701370. Epub 2020 Mar 3.

Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP])

Andres M Rubiano  1 , David S Vera  2 , Jorge H Montenegro  3 , Nancy Carney  4 , Angelica Clavijo  5 , Jose N Carreño  6 , Oscar Gutierrez  7 , Jorge Mejia  8 , Juan D Ciro  9 , Ninel D Barrios  10 , Alvaro R Soto  11 , Paola A Tejada  12 , Maria C Zerpa  13 , Alejandro Gomez  14 , Norberto Navarrete  15 , Oscar Echeverry  16 , Mauricio Umaña  17 , Claudia M Restrepo  18 , Jose L Castillo  19 , Oscar A Sanabria  20 , Maria P Bravo  21 , Claudia M Gomez  22 , Daniel A Godoy  23 , German D Orjuela  24 , Augusto A Arias  25 , Raul A Echeverri  26 , Jorge Paranos  27
Affiliations

Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP])

Andres M Rubiano et al. J Neurosci Rural Pract. 2020 Jan.

Abstract

Background Traumatic brain injury (TBI) is a global public health problem. In Colombia, it is estimated that 70% of deaths from violence and 90% of deaths from road traffic accidents are TBI related. In the year 2014, the Ministry of Health of Colombia funded the development of a clinical practice guideline (CPG) for the diagnosis and treatment of adult patients with severe TBI. A critical barrier to the widespread implementation was identified-that is, the lack of a specific protocol that spans various levels of resources and complexity across the four treatment phases. The objective of this article is to present the process and recommendations for the management of patients with TBI in various resource environments, across the treatment phases of prehospital care, emergency department (ED), surgery, and intensive care unit. Methods Using the Delphi methodology, a consensus of 20 experts in emergency medicine, neurosurgery, prehospital care, and intensive care nationwide developed recommendations based on 13 questions for the management of patients with TBI in Colombia. Discussion It is estimated that 80% of the global population live in developing economies where access to resources required for optimum treatment is limited. There is limitation for applications of CPGs recommendations in areas where there is low availability or absence of resources for integral care. Development of mixed methods consensus, including evidence review and expertise points of good clinical practices can fill gaps in application of CPGs. BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol) is intended to be a practical handbook for care providers to use to treat TBI patients with whatever resources are available. Results Stratification of recommendations for interventions according to the availability of the resources on different stages of integral care is a proposed method for filling gaps in actual evidence, to organize a better strategy for interventions in different real-life scenarios. We develop 10 algorithms of management for building TBI protocols based on expert consensus to articulate treatment options in prehospital care, EDs, neurological surgery, and intensive care, independent of the level of availability of resources for care.

Keywords: Colombia; critical care; emergency care; guideline; intensive care; prehospital care; traumatic brain injuries.

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Conflict of interest statement

NoteAuthors’ ContributionsConflict of Interest No human subjects were involved in this work. Andrés M. Rubiano, MD, PhD(c): Principal investigator, senior author. David S. Vera, MD, José N. Carreño, MD, Oscar Gutiérrez, MD, Jorge Mejía, MD, MSc, Juan D. Ciro, MD, Ninel D. Barrios, MD, Alvaro R. Soto, MD, Paola A. Tejada, MD, MSC, PhD, Maria C. Zerpa, MD, Alejandro Gómez, TAPH, MD, Norberto Navarrete, MD, MSc, Oscar Echeverry, TAPH, Mauricio Umaña, MD, Claudia M. Restrepo, MD, José L. Castillo, MD, Oscar A. Sanabria, MD, Maria P. Bravo, MD, Claudia M. Gómez, MD, Daniel A. Godoy, MD, German D. Orjuela, TAPH, Augusto A. Arias, MD, Raul A. Echeverri, MD, Jorge Paraños, MD: Coinvestigators, coauthors. Jorge H. Montenegro, MD, Nancy Ann Carney, PhD, and Angelica Clavijo MD: Coninvestigators, coauthors also. None declared.

Figures

Fig. 1
Fig. 1
Three-dimensional stratified scheme according to the level of resources and complexity.
Fig. 2
Fig. 2
Management algorithm of the patient with traumatic brain injury (TBI) in basic emergency transport (BET).
Fig. 3
Fig. 3
Management algorithm of the patient with traumatic brain injury (TBI) in advanced emergency transport (AET).
Fig. 4
Fig. 4
Trauma Care Checklist. Source: World Health Organization. Available at: https://www.who.int/publications-detail/trauma-care-checklist
Fig. 5
Fig. 5
Management algorithm of the patient with traumatic brain injury (TBI) in a low complexity ED (without CT).
Fig. 6
Fig. 6
Management algorithm of the patient with traumatic brain injury (TBI) in a medium or high complexity emergency department (ED) (with computed tomography [CT]).
Fig. 7
Fig. 7
Management algorithm of patient with traumatic brain injury (TBI) who requires immediate surgery.
Fig. 8
Fig. 8
Management algorithm of patient with moderate to severe traumatic brain injury (TBI) in service of intermediate care.
See this image and copyright information in PMC

Comment in

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