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Objetivos América Latina se encuentra entre varias regiones del mundo que carecen de datos sólidos sobre lesiones por neurotrauma. Este proyecto de investigación buscó investigar un registro multiinstitucional de lesiones cerebrales en Colombia, América del Sur, mediante la realización de un estudio cualitativo para identificar los factores que afectan la creación e implementación de un registro multiinstitucional de TBI en Colombia antes del establecimiento del registro actual. Métodos Las entrevistas con informantes clave y la observación participante identificaron barreras y facilitadores para la creación de un registro de LCT en tres instituciones de atención médica en este país de ingresos medianos altos de América del Sur. Resultados El estudio identificó barreras para la implementación que involucran datos clínicos incompletos, recursos limitados, falta de soporte de información y tecnología (TI), limitaciones de tiempo y dificultades con la aprobación ética. Estas barreras reflejaron resultados similares de otros estudios de implementación de registros en países de bajos y medianos ingresos (LMIC). La facilidad de uso y la integración de la recopilación de datos en el flujo de trabajo clínico, el apoyo local para el registro, la motivación personal y los posibles usos futuros del registro para mejorar la atención y guiar la investigación se identificaron como facilitadores de la implementación. Las partes interesadas identificaron campeones locales y el apoyo de la administración de cada institución como esenciales para el éxito del proyecto. Conclusión Las barreras para la implementación de un registro de neurotrauma en Colombia incluyen datos clínicos incompletos, recursos limitados y falta de soporte de TI. Algunos factores para mejorar el proceso de implementación incluyen el apoyo local, la motivación personal y los posibles usos de los datos del registro para mejorar la atención a nivel local. La información de este estudio puede ayudar a guiar los esfuerzos futuros para establecer registros de neurotrauma en América Latina y en los LMIC. Objectives Latin America is among several regions of the world that lacks robust data on injuries due to neurotrauma. This research project sought to investigate a multi-institution brain injury registry in Colombia, South America, by conducting a qualitative study to identify factors affecting the creation and implementation of a multi-institution TBI registry in Colombia before the establishment of the current registry. Methods Key informant interviews and participant observation identified barriers and facilitators to the creation of a TBI registry at three health care institutions in this upper-middle-income country in South America. Results The study identified barriers to implementation involving incomplete clinical data, limited resources, lack of information and technology (IT) support, time constraints, and difficulties with ethical approval. These barriers mirrored similar results from other studies of registry implementation in low- and middle-income countries (LMICs). Ease of use and integration of data collection into the clinical workflow, local support for the registry, personal motivation, and the potential future uses of the registry to improve care and guide research were identified as facilitators to implementation. Stakeholders identified local champions and support from the administration at each institution as essential to the success of the project. Conclusion Barriers for implementation of a neurotrauma registry in Colombia include incomplete clinical data, limited resources and lack of IT support. Some factors for improving the implementation process include local support, personal motivation and potential uses of the registry data to improve care locally. Information from this study may help to guide future efforts to establish neurotrauma registries in Latin America and in LMICs.

Spinal cord injury (SCI) is a disease that affects the normal function of the spinal cord. Road traffic accidents (RTAs) represent the main cause of SCI worldwide. SCI may generate physical disability and economic dependency, which is especially significant in low- and middle-income countries such as most of the Latin American countries. The main objective of this study was to present an epidemiological review of SCI secondary to RTAs. Stronger evidence on this condition in Latin America is important for future-specific data collection and prevention strategies. A literature review was carried out using specific search strategies in databases of indexed journals from the period 2000 to 2019. Data on SCI secondary to RTAs in the Latin American region were collected and analyzed. After initial screening and removal of duplicates, 16 articles met the inclusion criteria and were chosen for analysis. Data from 7 Latin American countries were retrievable. On average, RTAs were responsible for 40.81% of SCI. Data from different studies are heterogeneous. Car accidents and moto accidents were equally responsible for SCIs (50.61% vs. 49.06%). The thoracic segments were the most commonly affected (57.87%). Males in their 30s were the most affected category (76.6%). SCI due to RTAs may represent a severe but preventable condition that affects mostly men in their productive age, generating important social and economic issues. Data about this condition in Latin America are scarce, and could limit prevention and treatment strategies. Prospective data collection about this condition is recommended.

Sesenta y nueve millones de personas tienen una lesión cerebral traumática (TBI) cada año, y la TBI es la causa más común de hemorragia subaracnoidea (HSA). La HAS traumática (TSAH) se ha descrito como un factor pronóstico adverso que conduce a un deterioro neurológico progresivo y a un aumento de la morbilidad y la mortalidad. Sin embargo, un número limitado de estudios evalúa las tendencias recientes en el diagnóstico y manejo de la HSA en el contexto del trauma. El objetivo de esta revisión de alcance fue comprender el alcance y el tipo de evidencia sobre los criterios de diagnóstico y manejo de TSAH. Esta revisión de alcance se realizó siguiendo la metodología del Instituto Joanna Briggs para revisiones de alcance. La revisión incluyó adultos con HSA secundaria a trauma, donde TSAH aislada (iTSAH) se refiere a la presencia de SAH en ausencia de cualquier otra patología intracraneal radiográfica traumática, y TSAH se refiere a la presencia de SAH con la posibilidad o presencia de una lesión radiográfica traumática adicional. patología intracraneal. Los datos extraídos de cada estudio incluyeron el objetivo del estudio, el país, la metodología, las características de la población, las medidas de resultado, un resumen de los hallazgos y las directivas futuras. Treinta estudios cumplieron los criterios de inclusión. Los estudios se agruparon en cinco categorías por tema: TSAH asociado con TBI leve (mTBI), n = 13) y TBI grave (n = 3); manejo clínico y diagnóstico (n = 9); imágenes (n = 3); y TSAH aneurismático (n = 1). De los 30 estudios, dos procedían de un país de ingresos bajos y medios (LMIC), excluyendo China, casi un país de ingresos altos. Los pacientes con TSAH asociado con mTBI tienen un riesgo muy bajo de deterioro clínico e intervención quirúrgica y deben ser tratados de forma conservadora al considerar la admisión en la unidad de cuidados intensivos. Los sistemas de puntuación de tomografía computarizada de Helsinki y Estocolmo, además de la Escala Americana de Lesiones, el nivel de creatinina, el árbol de decisión de la edad, pueden ser herramientas valiosas para predecir el resultado y la muerte. Sixty-nine million people have a 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 increased morbidity and mortality. A limited number of studies, however, evaluate recent trends in the diagnosis and management of SAH in the context of trauma. The objective of this scoping review was to understand the extent and type of evidence concerning the diagnostic criteria and management of TSAH. This scoping review was conducted following the Joanna Briggs Institute methodology for scoping reviews. The review included adults with SAH secondary to trauma, where isolated TSAH (iTSAH) refers to the presence of SAH in the absence of any other traumatic radiographic intracranial pathology, and TSAH refers to the presence of SAH with the possibility or presence of additional traumatic radiographic intracranial pathology. Data extracted from each study included study aim, country, methodology, population characteristics, outcome measures, a summary of findings, and future directives. Thirty studies met inclusion criteria. Studies were grouped into five categories by topic: TSAH associated with mild TBI (mTBI), n = 13), and severe TBI (n = 3); clinical management and diagnosis (n = 9); imaging (n = 3); and aneurysmal TSAH (n = 1). Of the 30 studies, two came from a low-and middle-income country (LMIC), excluding China, nearly a high-income country. Patients with TSAH associated with mTBI have a very low risk of clinical deterioration and surgical intervention and should be treated conservatively when considering intensive care unit admission. The Helsinki and Stockholm computed tomography scoring systems, in addition to the American Injury Scale, creatinine level, age decision tree, may be valuable tools to use when predicting outcome and death.

Background 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

ANTECEDENTES: La lesión cerebral traumática (LCT) será la tercera causa de muerte en todo el mundo, según la OMS. Dos encuestas europeas sugirieron que el cumplimiento de las directrices sobre traumatismos craneoencefálicos es deficiente. Ningún estudio ha comparado el cumplimiento entre países de ingresos bajos (LMIC) y países de ingresos altos (UHIC). Por lo tanto, este estudio tuvo como objetivo investigar las diferencias en el manejo de pacientes con TBI grave, comparando ingresos bajos y altos, y la adherencia a las pautas de BTF. MÉTODOS: se difundió una encuesta basada en la web a través de la fundación global Neuro, diferentes sociedades neuroquirúrgicas y las redes sociales. RESULTADOS: participaron un total de 803 neurocirujanos: 70,4 de UHIC y 29,6% de LMIC. El 73 % y el 65 % de los que respondieron en LMIC y UHIC, respectivamente (P = 0,016), administraron hipertónico como medida temprana. El 66 % y el 58 % de los neurocirujanos de los LMIC y los UHIC recomendaron una monitorización invasiva de la presión intracraneal, respectivamente (p

Background Many health care facilities in low- and middle-income countries are inadequately resourced. COVID-19 has the potential to decimate surgical health care services unless health systems take stringent measures to protect health care workers from viral exposure and ensure the continuity of specialized care for patients. Among these measures, the timely diagnosis of COVID-19 is paramount to ensure the use of protective measures and isolation of patients to prevent transmission to health care personnel caring for patients with an unknown COVID-19 status or contact during the pandemic. Besides molecular and antibody tests, chest computed tomography (CT) has been assessed as a potential tool to aid in the screening or diagnosis of COVID-19 and could be valuable in the emergency care setting. Objective This paper presents the protocol for an umbrella review that aims to identify and summarize the available literature on the diagnostic accuracy of chest CT for COVID-19 in trauma surgery patients requiring urgent care. The objective is to inform future recommendations on emergency care for this category of patients. Methods We will conduct several searches in the L·OVE (Living Overview of Evidence) platform for COVID-19, a system that performs automated regular searches in PubMed, Embase, Cochrane Central Register of Controlled Trials, and over 30 other sources. The search results will be presented according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis). This review will preferentially consider systematic reviews of diagnostic test accuracy studies, as well as individual studies of such design, if not included in the systematic reviews, that assessed the sensitivity and specificity of chest CT in emergency trauma surgery patients. Critical appraisal of the included studies for risk of bias will be conducted. Data will be extracted using a standardized data extraction tool. Findings will be summarized narratively, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to grade the certainty of evidence. 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 October 2020, and we expect to publish the findings in early 2021. The plan for dissemination is to publish the findings in a peer-reviewed journal and present our results at conferences that engage the most pertinent stakeholders. Conclusions During the COVID-19 pandemic, protecting health care workers from infection is essential. Up-to-date information on the efficacy of diagnostic tests for detecting COVID-19 is essential. This review will serve an important role as a thorough summary to inform evidence-based recommendations on establishing effective policy and clinical guideline recommendations. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020198267; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=198267 International Registered Report Identifier (IRRID) PRR1-10.2196/25207