Title : Non-invasive monitoring in acute TBI patients: Proposal of an algorithm when the CT scan is unavailable in centers health of LMIC
Abstract:
Background: Traumatic Brain Injury (TBI) is considered one of the main causes of disability and mortality in the worldwide1,2,3. For its prompt diagnosis and adequate management, it is essential to have the necessary technology as well as experienced health professionals. The main issue in health centers of Low Middle-Income Countries (LMIC) is not having either of these two tools or they are present but inefficiently, thus decreasing patient survival notoriously4. The newness of we propose: how to assess a neurocritical patient and recognize an increase in Intracranial Hypertension (IH) in an environment where a CT scan is not available.
Hypothesis: We propose a clinical and useful protocol for the initial care and attention of patients with severe traumatic brain injury (TBI) in Low Resource Health Centers (LMIC), precisely in the context in which CT is not available: with the main objective of highlighting those patients who must be referred to a highly complex hospital (with ICU and Neurosurgeon service available) and those who do not.
Methodology: This clinical algorithm only includes those patients admitted to the emergency room (ER), over 18 years old >, with a recent diagnosis of TBI less than 72 hours < and Glasgow Scale (GCS) less than 13 <. On the other hand, this protocol is designed to be carried out in a low-resource hospital in which a CTscan is not available. Each patient will be evaluated individually continuously over a period of 7 days (mean). The key diagnostic tool that replaces CTscan is non-invasive and will be detailed in the protocol. This algorithm excludes those patients under 18 years of age <, with GCS greater than 3 <, recent cardiac arrest, who do not have an accurate diagnosis of TBI or whose onset time after diagnosis is greater than 72 hours >. The difficulty in understanding this algorithm is low, so it is designed to be carried out by junior resident doctors, and supervised by senior residents.
