{
  "abstract": "Introduction Traumatic brain injury (TBI), a leading cause of global morbidity and mortality, has notably poorer outcomes in resource-poor settings. Managing TBI effectively requires functional integration of several interdependent phases of care which, in resource-poor settings, may be both individually fragile and poorly coordinated. However, there is a paucity of global data quantifying systemic deficiencies in TBI care across varying resource settings which hinders targeted improvement. To address this, we present an analysis of site surveys from centres contributing to the Global Neurotrauma Outcomes Study, to illustrate the global variation in health system performance with respect to TBI management.Methods The GNOS was a prospective, international, multicentre cohort study conducted between 1 November 2018 and 31 January 2020 across 159 centres that perform emergency surgery for TBI. Participating centres completed a 50-point site survey, assessing local resource availability and guideline usage across the TBI care pathway, including prehospital, intraoperative and rehabilitative care. Responses were stratified by each country’s Human Development Index (HDI).Results The site survey was completed by 153/159 (96%) centres. Variation in resource availability across HDI strata was least prevalent within operating theatres, whereas the biggest disparities were observed in prehospital and rehabilitation care. Resource-poor settings reported deficiencies in both the capital resources and skilled human resources needed to deliver TBI care. Overall, participants most commonly suggested that improvements in prehospital care would have the greatest impact on patient outcomes in TBI (53/153, 35%), although participants from the more resource-poor settings more commonly suggested improvements in intensive care management (6/14, 43%).Conclusion There are profound HDI-associated disparities in the resources for TBI care, which likely account for the global variation in patient mortality. Our study suggests improving the provision of non-operative interventions within TBI care pathways may offer the most successful approach to improve patient outcomes.Trial registration number NCT04212754.",
  "authors": [
    {
      "affiliations": [
        "International Health Systems Group, University of Cambridge Department of Engineering, Cambridge, UK"
      ],
      "name": "Adarsh Arun Menon"
    },
    {
      "affiliations": [
        "NIHR Global Health Research Group on Neurotrauma, Cambridge, England, UK"
      ],
      "name": "David Clark"
    },
    {
      "affiliations": [
        "International Health Systems Group, University of Cambridge Department of Engineering, Cambridge, UK"
      ],
      "name": "Michael F Bath"
    },
    {
      "affiliations": [
        "International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK"
      ],
      "name": "Sara Venturini"
    },
    {
      "affiliations": [
        "NIHR Global Health Research Group on Neurotrauma, Cambridge, England, UK"
      ],
      "name": "Mohammed Bashir"
    },
    {
      "affiliations": [
        "NIHR Global Health Research Group on Neurotrauma, Cambridge, England, UK"
      ],
      "name": "Alexis Joannides"
    },
    {
      "affiliations": [
        "Department of Surgery, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria"
      ],
      "name": "Amos O Adeleye"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Dr Soetomo Regional General Hospital, Surabaya, East Java, Indonesia"
      ],
      "name": "Abdul Hafid Bajamal"
    },
    {
      "affiliations": [
        "Neurosurgery Unit, Department of Surgery, Addis Ababa University College of Health Sciences, Addis Ababa, Addis Ababa, Ethiopia"
      ],
      "name": "Hagos Biluts"
    },
    {
      "affiliations": [
        "NIHR Global Health Research Group on Neurotrauma, Cambridge, England, UK"
      ],
      "name": "Karol Budohoski"
    },
    {
      "affiliations": [
        "NIHR Global Health Research Group on Neurotrauma, Cambridge, England, UK"
      ],
      "name": "Ari Ercole"
    },
    {
      "affiliations": [
        "NIHR Global Health Research Group on Neurotrauma, Cambridge, England, UK"
      ],
      "name": "Rocío Fernández-Méndez"
    },
    {
      "affiliations": [
        "Division of Neurosurgery, Red Cross Children’s Hospital & University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Anthony Figaji"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, All India Institute of Ayurveda, New Delhi, DL, India"
      ],
      "name": "Deepak Gupta"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA"
      ],
      "name": "Roger Härtl"
    },
    {
      "affiliations": [
        "Neurosurgery Division, University Hospital of Parma, Parma, Emilia-Romagna, Italy"
      ],
      "name": "Corrado Iaccarino"
    },
    {
      "affiliations": [
        "Northwest General Hospital & Research Centre, Peshawar, N.W.F.P, Pakistan"
      ],
      "name": "Tariq Khan"
    },
    {
      "affiliations": [
        "Neurosurgery Unit, Addis Ababa University College of Health Sciences, Addis Ababa, Addis Ababa, Ethiopia"
      ],
      "name": "Tsegazeab Laeke"
    },
    {
      "affiliations": [
        "Neurosciences Institute, Universidad El Bosque, Bogota, Cundinamarca, Colombia"
      ],
      "name": "Andres M Rubiano"
    },
    {
      "affiliations": [
        "Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania"
      ],
      "name": "Hamisi K Shabani"
    },
    {
      "affiliations": [
        "Neurosurgery Division, University of Zambia University Teaching Hospital, Lusaka, Lusaka Province, Zambia"
      ],
      "name": "Kachinga Sichizya"
    },
    {
      "affiliations": [
        "Post Graduate Institute of Medical Education and Research, Chandigarh, CH, India"
      ],
      "name": "Manoj Tewari"
    },
    {
      "affiliations": [
        "Neurosurgery Unit, Addis Ababa University College of Health Sciences, Addis Ababa, Addis Ababa, Ethiopia"
      ],
      "name": "Abenezer Tirsit"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Yangon General Hospital, Yangon, Yangon Region, Myanmar"
      ],
      "name": "Myat Thu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, CH, India"
      ],
      "name": "Manjul Tripathi"
    },
    {
      "affiliations": [
        "NIHR Global Health Research Group on Neurotrauma, Cambridge, England, UK"
      ],
      "name": "Rikin Trivedi"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore, India"
      ],
      "name": "Bhagavatula Indira Devi"
    },
    {
      "affiliations": [
        "Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy"
      ],
      "name": "Franco Servadei"
    },
    {
      "affiliations": [
        "Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, England, UK"
      ],
      "name": "David Menon"
    },
    {
      "affiliations": [
        "NIHR Global Health Research Group on Neurotrauma, Cambridge, England, UK"
      ],
      "name": "Angelos Kolias"
    },
    {
      "affiliations": [
        "International Health Systems Group, University of Cambridge Department of Engineering, Cambridge, UK",
        "NIHR Global Health Research Group on Neurotrauma, Cambridge, England, UK"
      ],
      "name": "Tom Bashford"
    },
    {
      "affiliations": [
        "NIHR Global Health Research Group on Neurotrauma, Cambridge, England, UK"
      ],
      "name": "Peter Hutchinson"
    },
    {
      "affiliations": [],
      "name": "Global Neurotrauma Outcomes Study collaborative"
    }
  ],
  "title": "Outlining the global variation in resources for traumatic brain injury care: site-level data from the Global Neurotrauma Outcomes Study (GNOS)",
  "uid": "bc7874d5-2682-5ee2-8e18-2b99cd5147a1"
}