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  • 1
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    Online Resource
    International Neurotrauma Training Based on North-South Collaborations: Results of an Inter-institutional Program in the Era of Global Neurosurgery
    Frontiers Media SA ; 2021
    In:  Frontiers in Surgery Vol. 8 ( 2021-7-29)
    Details
    In: Frontiers in Surgery, Frontiers Media SA, Vol. 8 ( 2021-7-29)
    Abstract: Objective: Shortage of general neurosurgery and specialized neurotrauma care in low resource settings is a critical setback in the national surgical plans of low and middle-income countries (LMIC). Neurotrauma fellowship programs typically exist in high-income countries (HIC), where surgeons who fulfill the requirements for positions regularly stay to practice. Due to this issue, neurosurgery residents and medical students from LMICs do not have regular access to this kind of specialized training and knowledge-hubs. The objective of this paper is to present the results of a recently established neurotrauma fellowship program for neurosurgeons of LMICs in the framework of global neurosurgery collaborations, including the involvement of specialized parallel education for neurosurgery residents and medical students. Methods: The Global Neurotrauma Fellowship (GNTF) program was inaugurated in 2015 by a multi-institutional collaboration between a HIC and an LMIC. The course organizers designed it to be a 12-month program based on adapted neurotrauma international competencies with the academic support of the Barrow Neurological Institute at Phoenix Children's Hospital and Meditech Foundation in Colombia. Since 2018, additional support from the UK, National Institute of Health Research (NIHR) Global Health Research in Neurotrauma Project from the University of Cambridge enhanced the infrastructure of the program, adding a research component in global neurosurgery and system science. Results: Eight fellows from Brazil, Venezuela, Cuba, Pakistan, and Colombia have been trained and certified via the fellowship program. The integration of international competencies and exposure to different systems of care in high-income and low-income environments creates a unique environment for training within a global neurosurgery framework. Additionally, 18 residents (Venezuela, Colombia, Ecuador, Peru, Cuba, Germany, Spain, and the USA), and ten medical students (the United Kingdom, USA, Australia, and Colombia) have also participated in elective rotations of neurotrauma and critical care during the time of the fellowship program, as well as in research projects as part of an established global surgery initiative. Conclusion: We have shown that it is possible to establish a neurotrauma fellowship program in an LMIC based on the structure of HIC formal training programs. Adaptation of the international competencies focusing on neurotrauma care in low resource settings and maintaining international mentoring and academic support will allow the participants to return to practice in their home-based countries.
    Type of Medium: Online Resource
    ISSN: 2296-875X
    URL: Article
    DOI: 10.3389/fsurg.2021.633774
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2773823-1
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  • 2
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    Severe Pediatric TBI Management in a Middle-Income Country and a High-Income Country: A Comparative Assessment of Two Centers
    Frontiers Media SA ; 2021
    In:  Frontiers in Surgery Vol. 8 ( 2021-8-12)
    Details
    In: Frontiers in Surgery, Frontiers Media SA, Vol. 8 ( 2021-8-12)
    Abstract: Background: Traumatic brain injury (TBI) is a global public health issue with over 10 million deaths or hospitalizations each year. However, access to specialized care is dependent on institutional resources and public health policy. Phoenix Children's Hospital USA (PCH) and the Neiva University Hospital, Colombia (NUH) compared the management and outcomes of pediatric patients with severe TBI over 5 years to establish differences between outcomes of patients managed in countries of varying resources availability. Methods: We conducted a retrospective review of individuals between 0 and 17 years of age, with a diagnosis of severe TBI and admitted to PCH and NUH between 2010 and 2015. Data collected included Glasgow coma scores, intensive care unit monitoring, and Glasgow outcome scores. Pearson Chi-square, Fisher exact, T -test, or Wilcoxon-rank sum test was used to compare outcomes. Results: One hundred and one subjects met the inclusion criteria. NUH employed intracranial pressure monitoring less frequently than PCH ( p = 0.000), but surgical decompression and subdural evacuation were higher at PCH ( p = 0.031 and p = 0.003). Mortality rates were similar between the institutions (15% PCH, 17% NUH) as were functional outcomes (52% PCH, 54% NUH). Conclusions: Differences between centers included time to specialized care and utilization of monitoring. No significant differences were evidenced in survival and the overall functional outcomes.
    Type of Medium: Online Resource
    ISSN: 2296-875X
    URL: Article
    DOI: 10.3389/fsurg.2021.670546
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2773823-1
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  • 3
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    Personal protective equipment for reducing the risk of COVID-19 infection among health care workers involved in emergency trauma surgery during the pandemic: An umbrella review
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of Trauma and Acute Care Surgery Vol. 90, No. 4 ( 2021-4), p. e72-e80
    Details
    In: Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 90, No. 4 ( 2021-4), p. e72-e80
    Abstract: Health care facilities in low- and middle-income countries are inadequately resourced to adhere to current COVID-19 prevention recommendations. Recommendations for surgical emergency trauma care measures need to be adequately informed by available evidence and adapt to particular settings. To inform future recommendations, we set to summarize the effects of different personal protective equipment (PPE) on the risk of COVID-19 infection in health personnel caring for trauma surgery patients. METHODS We conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. Systematic reviews of experimental and observational studies assessing the efficacy of PPE were included. Indirect evidence from other health care settings was also considered. Risk of bias was assessed with the AMSTAR II tool (Assessing the Methodological Quality of Systematic Reviews, Ottawa, ON, Canada), and the Grading of Recommendations, Assessment, Development, and Evaluation approach for grading the certainty of the evidence is reported (registered in International Prospective Register of Systematic Reviews, CRD42020198267). RESULTS Eighteen studies that fulfilled the selection criteria were included. There is high certainty that the use of N95 respirators and surgical masks is associated with a reduced risk of COVID-19 when compared with no mask use. In moderate- to high-risk environments, N95 respirators are associated with a further reduction in risk of COVID-19 infection compared with surgical masks. Eye protection also reduces the risk of contagion in this setting. Decontamination of masks and respirators with ultraviolet germicidal irradiation, vaporous hydrogen peroxide, or dry heat is effective and does not affect PPE performance or fit. CONCLUSION The use of PPE drastically reduces the risk of COVID-19 compared with no mask use in health care workers. N95 and equivalent respirators provide more protection than surgical masks. Decontamination and reuse appear feasible to overcome PPE shortages and enhance the allocation of limited resources. These effects are applicable to emergency trauma care and should inform future recommendations. LEVEL OF EVIDENCE Review, level II.
    Type of Medium: Online Resource
    ISSN: 2163-0763 , 2163-0755
    URL: Article
    DOI: 10.1097/TA.0000000000003073
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2651313-4
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  • 4
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    Implementation of the infrascanner in the detection of post-traumatic intracranial bleeding: A narrative review.
    Elsevier BV ; 2022
    In:  Brain Disorders Vol. 5 ( 2022-03), p. 100026-
    Details
    In: Brain Disorders, Elsevier BV, Vol. 5 ( 2022-03), p. 100026-
    Type of Medium: Online Resource
    ISSN: 2666-4593
    URL: Article
    DOI: 10.1016/j.dscb.2021.100026
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 3063573-1
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  • 5
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    Diagnosis and Management of Traumatic Subarachnoid Hemorrhage: Protocol for a Scoping Review
    JMIR Publications Inc. ; 2021
    In:  JMIR Research Protocols Vol. 10, No. 10 ( 2021-10-20), p. e26709-
    Details
    In: JMIR Research Protocols, JMIR Publications Inc., Vol. 10, No. 10 ( 2021-10-20), p. e26709-
    Abstract: Globally, 69 million people suffer from traumatic brain injury (TBI) each year and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and an increase in morbidity and mortality, but there are a limited number of studies which evaluate recent trends in the diagnostic and management of SAH in the context of trauma. Objective The objective of this scoping review was to understand the extent and type of evidence in relation to the diagnostic criteria and management of TSAH. Methods This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. A 3-step search strategy (an initial limited search in PubMed and Scopus databases; a main search of EMBASE, Web of Science, EBSCO, MEDLINE; and manual searches of reference lists of included articles) will be utilized. The search will be limited to studies with human participants and published in English, Spanish, and French between 2005 and 2020. This review will consider studies of adolescent and adult patients with SAH secondary to trauma. Study selection will be performed by 2 authors (DG and LF) in a 2-phase process; if any disagreement arises, a third author (AR) will be consulted. Data to be extracted from each study will include population, intervention, comparator and outcome measures, and a summary of findings. Citation screening, full-text review, risk of bias assessment, and extraction of study characteristics and outcomes will be carried out using a web-based software platform that streamlines the production of scoping reviews. Results Ethics approval is not required for this systematic review, as there will be no patient involvement. The search for this systematic review commenced in December 2020, and we expect to publish the findings in early 2021. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at conferences that engage the most pertinent stakeholders. Conclusions This scoping review will serve as an initial step in providing more evidence for health care professionals, economists, and policymakers so that they might devote more resources toward this significant problem affecting both health and economic outcomes worldwide. International Registered Report Identifier (IRRID) PRR1-10.2196/26709
    Type of Medium: Online Resource
    ISSN: 1929-0748
    URL: Article
    DOI: 10.2196/26709
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2021
    detail.hit.zdb_id: 2719222-2
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  • 6
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    Ability of Infrascanner 2000 to predict post-traumatic cranial hemorrhage volume in low-resource settings: a protocol for a multi-center prospective, observational study
    Oxford University Press (OUP) ; 2022
    In:  Journal of Surgical Protocols and Research Methodologies Vol. 2022, No. 1 ( 2022-01-01)
    Details
    In: Journal of Surgical Protocols and Research Methodologies, Oxford University Press (OUP), Vol. 2022, No. 1 ( 2022-01-01)
    Abstract: Low- and middle-income countries experience three times more traumatic brain injury (TBI) cases when compared with their high-income country counterparts. The quality of care patients receive in the prehospital setting and emergency department settings are highly variable and often dependent on computed tomography (CT) availability. The implementation of a handheld device that is able to reliably diagnose intracranial hemorrhage (ICrH) in TBI patients is needed in these settings where CT is unavailable. The Infrascanner has shown promise to detect intracranial bleeds in patients with moderate TBI. We aim to determine the correlation between the coefficient provided by the Infrascanner compared to the post-traumatic supratentorial hemorrhagic collections volume in patients with surgical indication in differente trauma centers. This is a multi-center prospective observational study that will be carried out in three trauma centers in Colombia, Guatemala and Pakistan. We calculated a sample size of eighty-six patients with mild, moderate or severe TBI ≥ 15 years old who have a supratentorial hemorrhage abnormality that requires neurosurgical intervention. The Infrascanner’s ability to detect IChR in patients with surgical indications associated to hemorrhage volume when compared with CT is the primary outcome measure. Secondary outcome measure is the correlation of the mean of the six Infrascanner measurement values compared with volume of ICrH as measured from the six manual head CT segmentation measurements. ICrH volume correlation and agreement will be evaluated by the Pearson coefficient and Bland-Altman analysis, and a linear regression analysis will be performed in order to predict IChR from the Infrascanner measurement.
    Type of Medium: Online Resource
    ISSN: 2752-616X
    URL: Article
    DOI: 10.1093/jsprm/snac004
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 3104184-X
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  • 7
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    Online Resource
    A diagnostic, test-accuracy study to evaluate the ability of the Eye Guide Visual Tracking System and the Post-Concussion Symptom Scale to diagnose mild TBI and predict protracted recovery
    Oxford University Press (OUP) ; 2022
    In:  Journal of Surgical Protocols and Research Methodologies Vol. 2022, No. 4 ( 2022-10-07)
    Details
    In: Journal of Surgical Protocols and Research Methodologies, Oxford University Press (OUP), Vol. 2022, No. 4 ( 2022-10-07)
    Abstract: Mild traumatic brain injury (mTBI) is the most common type of traumatic brain injury (TBI), and 100–300 individuals per every 100 000 seek medical care for mTBI annually. The Eye Guide is a portable device that evaluates oculomotor function. This device has promising potential to detect trauma-related neurological deficits that are otherwise undetected by a non-contrast computed tomography scan, the current gold standard. However, to our knowledge, a study has yet to be conducted that evaluates its ability to detect mTBIs specifically. By contrast, the Post-Concussion Symptom Scale (PCSS) is a 22-item, self-reported symptom survey that has become one of the most trusted tools in evaluating mTBI-related sequelae. Although this scale has been well validated in adolescent athletes, there is a notable lack of studies defining its clinical utility in adults with non-sports-related trauma. Patients with mTBI are expected to have detectable alterations in the PCSS score and the Eye Guide visual tracing. Thus, this study aims to determine each tool’s diagnostic accuracy in detecting mTBI and prognostic accuracy in predicting a protracted recovery in our patient population. Additionally, for both tools, we seek to establish cut-off values for future clinical decision-making in non-athlete, adult populations. A prospective, observational cohort test-accuracy study will be conducted in two clinics that form part of the ValleSalud Clinic Network in Cali, Colombia. Both are Level III referral trauma centers. The sensitivity, specificity and positive predictive value of both the Eye Guide and PCSS tests in diagnosing mTBI and predicting protracted recovery will serve as primary outcomes of the study. Additionally, the area under the curve analyses will be undertaken to determine the optimal sensitivity and specificity cut-offs for each test. The ground truth labels will be the diagnosis of mTBI by neurological examination as evaluated by an experienced neurosurgeon and recovery at 1 month post-injury according to the Extended Glasgow Outcome Scale. This study will follow the principles set forth by the Declaration of Helsinki.
    Type of Medium: Online Resource
    ISSN: 2752-616X
    URL: Article
    DOI: 10.1093/jsprm/snab010
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 3104184-X
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  • 8
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    Online Resource
    A consensus statement for trauma surgery capacity building in Latin America
    Springer Science and Business Media LLC ; 2021
    In:  World Journal of Emergency Surgery Vol. 16, No. 1 ( 2021-12)
    Details
    In: World Journal of Emergency Surgery, Springer Science and Business Media LLC, Vol. 16, No. 1 ( 2021-12)
    Abstract: Trauma is a significant public health problem in Latin America (LA), contributing to substantial death and disability in the region. Several LA countries have implemented trauma registries and injury surveillance systems. However, the region lacks an integrated trauma system. The consensus conference’s goal was to integrate existing LA trauma data collection efforts into a regional trauma program and encourage the use of the data to inform health policy. Methods We created a consensus group of 25 experts in trauma and emergency care with previous data collection and injury surveillance experience in the LA. region. Experts participated in a consensus conference to discuss the state of trauma data collection in LA. We utilized the Delphi method to build consensus around strategic steps for trauma data management in the region. Consensus was defined as the agreement of ≥ 70% among the expert panel. Results The consensus conference determined that action was necessary from academic bodies, scientific societies, and ministries of health to encourage a culture of collection and use of health data in trauma. The panel developed a set of recommendations for these groups to encourage the development and use of robust trauma information systems in LA. Consensus was achieved in one Delphi round. Conclusions The expert group successfully reached a consensus on recommendations to key stakeholders in trauma information systems in LA. These recommendations may be used to encourage capacity building in trauma research and trauma health policy in the region.
    Type of Medium: Online Resource
    ISSN: 1749-7922
    URL: Article
    DOI: 10.1186/s13017-021-00347-2
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2233734-9
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  • 9
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    Online Resource
    Management of severe traumatic brain injury in regions with limited resources
    Informa UK Limited ; 2021
    In:  Brain Injury Vol. 35, No. 11 ( 2021-09-19), p. 1317-1325
    Details
    In: Brain Injury, Informa UK Limited, Vol. 35, No. 11 ( 2021-09-19), p. 1317-1325
    Type of Medium: Online Resource
    ISSN: 0269-9052 , 1362-301X
    URL: Article
    DOI: 10.1080/02699052.2021.1972149
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2021
    detail.hit.zdb_id: 2004054-4
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  • 10
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    Implementing a Neurotrauma Registry in Latin America and the Caribbean
    Scientific Scholar ; 2022
    In:  Journal of Neurosciences in Rural Practice Vol. 13 ( 2022-08-07), p. 525-528
    Details
    In: Journal of Neurosciences in Rural Practice, Scientific Scholar, Vol. 13 ( 2022-08-07), p. 525-528
    Abstract: Background  Traumatic brain injury (TBI) has a disproportionately greater impact in low- and middle-income countries (LMICs). One strategy to reduce the burden of disease in LMICs is through the implementation of a trauma registry that standardizes the assessment of each patient's management of care. Objective  This study aims to ascertain the interest of Latin America and the Caribbean (LAC) nations in establishing a shared neurotrauma registry in the regional block, based on an existing framework for collaboration. Methods  A descriptive review was performed regarding the interests of LAC nations in implementing a shared neurotrauma registry in their region. We convened a meeting with seven Caribbean and five Latin American nations. Results  One hundred percent ( n  = 12) of the LAC representatives including neurosurgeons, neurointensivists, ministers of health, and chief medical officers/emergency medical technicians (EMTs) agreed to adopt the registry for tracking the burden of TBI and associated pathologies within the region. Conclusion  The implementation of a neurotrauma registry can benefit the region through a shared database to track disease, improve outcomes, build research, and ultimately influence policy.
    Type of Medium: Online Resource
    ISSN: 0976-3155 , 0976-3147
    URL: Journal
    URL: Article
    DOI: 10.25259/JNRP
    DOI: 10.1055/s-0042-1745816
    Language: English
    Publisher: Scientific Scholar
    Publication Date: 2022
    detail.hit.zdb_id: 2601242-X
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