Journal – plos one
Article type – Journal research article – Clinical research
Publication date – Sep – 2022
Authors – Brandon G. Smith, Charlotte J. Whiffin , Ignatius N. Esene, Claire Karekezi, Tom Bashford, Muhammad Mukhtar Khan, Davi J. Fontoura Solla, Bhagavatula Indira Devi, Wellingson S. Paiva, Franco Servadei, Peter J. Hutchinson, Angelos G. Kolias , Anthony Figaji, Andres M. Rubiano
Keywords – low resource settings, low- and middle-income countries (LMICs), Neurotrauma, traumatic brain injury (TBI)
Open access – Yes
Speciality – Neurosurgery, Trauma surgery
World region Global

Language – English
Submitted to the One Surgery Index on October 1, 2022 at 12:01 am
Abstract:

Background
Traumatic brain injury (TBI) is a major global health issue, but low- and middle-income countries (LMICs) face the greatest burden. Significant differences in neurotrauma outcomes are recognised between LMICs and high-income countries. However, outcome data is not consistently nor reliably recorded in either setting, thus the true burden of TBI cannot be accurately quantified.

Objective
To explore the specific contextual challenges of, and possible solutions to improve, long-term follow-up following TBI in low-resource settings.

Methods
A cross-sectional, pragmatic qualitative study, that considered knowledge subjective and reality multiple (i.e. situated within the naturalistic paradigm). Data collection utilised semi-structured interviews, by videoconference and asynchronous e-mail. Data were analysed using Braun and Clarke’s six-stage Reflexive Thematic Analysis.

Results
18 neurosurgeons from 13 countries participated in this study, and data analysis gave rise to five themes: Clinical Context: What must we understand?; Perspectives and Definitions: What are we talking about?; Ownership and Beneficiaries: Why do we do it?; Lost to Follow-up: Who misses out and why?; Processes and Procedures: What do we do, or what might we do?

Conclusion
The collection of long-term outcome data plays an imperative role in reducing the global burden of neurotrauma. Therefore, this was an exploratory study that examined the contextual challenges associated with long-term follow-up in LMICs. Where technology can contribute to improved neurotrauma surveillance and remote assessment, these must be implemented in a manner that improves patient outcomes, reduces clinical burden on physicians, and does not surpass the comprehension, capabilities, or financial means of the end user. Future research is recommended to investigate patient and family perspectives, the impact on clinical care teams, and the full economic implications of new technologies for follow-up.

OSI Number – 21774

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