Methodology for the Formulation of the Guidelines for the Management of Moderate to Severe Traumatic Brain Injury in Austere and Combat Environments

Ross C Puffer¹, Andres M Rubiano^{2

3}, Simon Oczkowski^{4

5}, Gregory W J Hawryluk⁶, Jamshid Ghajar⁷, Halinder S Mangat^{8

9}, Randy Bell¹⁰, Jeffrey V Rosenfeld^{11

12

13}, Lynne Lourdes N Lucena¹⁴, William R Copeland 3rd¹⁵, Grant Mallory¹⁶, Scott Cota¹⁷, Bradley A Dengler^{1

18}

Affiliations

¹ Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
² Neurosciences Institute at Universidad El Bosque, Bogota, Colombia.
³ Meditech Foundation, Cali, Colombia.
⁴ Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁵ Guidelines in Intensive Care, Development, and Evaluation (GUIDE) Group, Hamilton, Ontario, Canada.
⁶ Neurological Institute, Cleveland Clinic, Akron General Hospital, Akron, Ohio, USA.
⁷ Department of Neurosurgery, Stanford University School of Medicine, Stanford University, Palo Alto, California, USA.
⁸ Brain Trauma Foundation, Palo Alto, California, USA.
⁹ Kansas University Medical Center Research Institute, Kansas City, Kansas, USA.
¹⁰ Department of Neurosurgery, Avera Medical Group, Sioux Falls, South Dakota, USA.
¹¹ Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia.
¹² Department of Surgery, Monash University, Melbourne, Australia.
¹³ Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
¹⁴ Neurosurgery Division, Department of Surgery, Bicol Regional Hospital and Medical Center, Legazpi City, Albay, Philippines.
¹⁵ Department of Neurosurgery, Kijabe Hospital, Kijabe, Kenya.
¹⁶ Department of Neurosurgery, San Antonio National Military Medical Center, San Antonio, Texas, USA.
¹⁷ USN-Branch Chief, Defense Health Agency (DHA) Traumatic Brain Injury Center of Excellence (TBICoE), Falls Church, Virginia, USA.
¹⁸ Military Traumatic Brain Injury Initiative, USUHS, Bethesda, Maryland, USA.

PMID: 39959901
PMCID: PMC11783653
DOI: 10.1227/neuprac.0000000000000104

Methodology for the Formulation of the Guidelines for the Management of Moderate to Severe Traumatic Brain Injury in Austere and Combat Environments

Ross C Puffer et al. Neurosurg Pract. 2024.

. 2024 Aug 15;5(3):e00104.

doi: 10.1227/neuprac.0000000000000104. eCollection 2024 Sep.

Authors

Affiliations

¹ Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
² Neurosciences Institute at Universidad El Bosque, Bogota, Colombia.
³ Meditech Foundation, Cali, Colombia.
⁴ Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁵ Guidelines in Intensive Care, Development, and Evaluation (GUIDE) Group, Hamilton, Ontario, Canada.
⁶ Neurological Institute, Cleveland Clinic, Akron General Hospital, Akron, Ohio, USA.
⁷ Department of Neurosurgery, Stanford University School of Medicine, Stanford University, Palo Alto, California, USA.
⁸ Brain Trauma Foundation, Palo Alto, California, USA.
⁹ Kansas University Medical Center Research Institute, Kansas City, Kansas, USA.
¹⁰ Department of Neurosurgery, Avera Medical Group, Sioux Falls, South Dakota, USA.
¹¹ Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia.
¹² Department of Surgery, Monash University, Melbourne, Australia.
¹³ Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
¹⁴ Neurosurgery Division, Department of Surgery, Bicol Regional Hospital and Medical Center, Legazpi City, Albay, Philippines.
¹⁵ Department of Neurosurgery, Kijabe Hospital, Kijabe, Kenya.
¹⁶ Department of Neurosurgery, San Antonio National Military Medical Center, San Antonio, Texas, USA.
¹⁷ USN-Branch Chief, Defense Health Agency (DHA) Traumatic Brain Injury Center of Excellence (TBICoE), Falls Church, Virginia, USA.
¹⁸ Military Traumatic Brain Injury Initiative, USUHS, Bethesda, Maryland, USA.

PMID: 39959901
PMCID: PMC11783653
DOI: 10.1227/neuprac.0000000000000104

Abstract

Care for the patient with traumatic brain injury (TBI) in austere or combat environments is challenging because resources are substantially limited as compared with care for these patients in a tertiary medical facility. Significant research has been and will continue to be performed on TBI care in these settings. This includes high-quality, evidence-based guidelines that are routinely updated to help guide the treating team as to best practices for a wide range of TBI presentations, complications, and outcomes. Much less is known regarding best practices for TBI care in a resource-limited environment, such as a facility in an austere environment without advanced imaging, dedicated neurointensive care, or definitive neurosurgical capabilities. The aim of this study was to identify the methodology that will be used for an upcoming in-person guideline conference, focusing on the care of patients with TBI in resource-limited austere and/or combat zones.

Keywords: Austere; Combat; Developing; Guideline; Interventions; Neurotrauma; TBI.

Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.

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Conflict of interest statement

Simon Oczkowski is a consultant with the Brain Trauma Foundation. Jamshid Ghajar is a consultant with the Department of Defense and the Brain Trauma Foundation. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Bradley A. Dengler is a consultant for the Department of Defense, Uniformed Services University, and the Military Traumatic Brain Injury Initiative.

References

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Methodology for the Formulation of the Guidelines for the Management of Moderate to Severe Traumatic Brain Injury in Austere and Combat Environments

Affiliations

Methodology for the Formulation of the Guidelines for the Management of Moderate to Severe Traumatic Brain Injury in Austere and Combat Environments

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources