Severe Traumatic Brain Injury in South America: The Association Between Resources and Outcomes

Abstract

The burden of death and disability due to traumatic brain injury is increasing in low and middle income countries. The optimal management strategies and utilization of medical resources in resource limited settings are unknown. This multinational prospective observational study evaluated the association between resources and outcomes from severe TBI in South America. 203 patients with severe TBI were treated in a designated high or low resource setting, reflecting variation in ICP monitoring technology. There were significant differences in prehospital transport, ICU admission, and use of ICP monitoring between study groups that may impact outcomes. Patients treated in a high resource setting had significant improvements in functional outcome, but not mortality, at 6 months post-injury. Multivariate regression models showed that resource setting, independent of ICP monitoring, predicted functional outcome at 6 months after severe TBI. Understanding the characteristics that explain this variation and guiding appropriate resource allocation may improve outcomes.