A global research group will map traumatic brain injury (TBI) care across eleven low- and middle-income countries (LMICs), from the roadside to the rehabilitation ward. TBI kills and disables millions of people each year, with the heaviest toll falling on LMICs. Yet no one has systematically documented what care actually looks like in these settings—how many patients arrive, what treatments they receive, or what happens to them afterward. Without that baseline, efforts to improve care often fail because they ignore the tangled realities of local equipment, staffing, funding, and politics. The group will build a web-based neurotrauma registry endorsed by the World Federation of Neurosurgical Societies, starting in partner hospitals in Colombia, Ethiopia, India, Indonesia, Malaysia, Myanmar, Nigeria, Pakistan, South Africa, Tanzania, and Zambia. A second theme will use systems modelling—borrowing tools from engineering—to untangle why care breaks down, initially focusing on Myanmar. If successful, the registry will become a permanent quality-improvement tool, enabling LMIC clinicians to track outcomes, spot failures, and test fixes. The work could also guide safer management of head injuries by non-neurosurgeons in rural areas, where specialist help is hours away.
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Traumatic brain injury (TBI) is a leading cause of death & disability around the world with LMICs facing the greatest burden of disease. We are well positioned to be leading the application for a Global Neurotrauma Research Group due to the track record of the neurotrauma programme in academic excellence, national leadership in systems engineering and public health. We have experience of working with partners in LMICs in delivering multicentre randomised trials (RESCUEicp & RESCUE-ASDH NIHR-funded trials) and have been selected as the first centre for global neurotrauma training by the World Federation of Neurosurgical Societies. We have established collaborations with partners in Colombia, Ethiopia, India, Indonesia, Malaysia, Myanmar, Nigeria, Pakistan, South Africa, Tanzania and Zambia. The delivery of neurotrauma care is complex, involving different teams, equipment, infrastructure, culture, political will, legal frameworks, and finance. The need to address this complexity is well recognised. The WHO have called for robust systems approaches to the development of care, particularly in LMICs, following a recognition that improving care and performing research flounders without an understanding of the multiple factors involved. While some groups have sought to apply 'systems thinking' to improving care in LMICs, this has largely been in isolation from established systems engineering researchers. Our intention is to work with our partners in LMICs in order to improve TBI clinical care and research leveraging our expertise in neurotrauma care and research, and systems engineering across four themes: THEME 1 - Mapping TBI Clinical Care: Volume, case mix, and current practice This theme aims to map the current landscape of TBI care provision in all partner countries. This is a priority for our LMIC partner organisations and a strategic priority for the World Federation of Neurosurgical Societies (WFNS; President elect Franco Servadei; co-applicant). Additionally, the establishment and maintenance of robust data collection mechanisms is a key target in the Global Surgery 2030 roadmap (3). Hence, we are proposing the establishment of a WFNS-endorsed neurotrauma registry in the partner institutions prior to wider dissemination. The web-based registry will map the pre-hospital, acute in-hospital (imaging, neurosurgery, intensive care), and post-acute care (access to rehabilitation) of TBI patients and will be used for defining the contemporary case mix and outcomes of TBI patients. We will also map the available resources and define the current status of measures used in terms of primary prevention (compared to HICs). This registry will aim to leverage the experience of Cambridge (neuro-informatics ORION unit), which is currently hosting similar registries in the UK on behalf of the Society of British Neurological Surgeons. The establishment of a registry as part of the 3-year project is a critical element of the long-term sustainability of Global Neurotrauma efforts, as it will be used by LMICs collaborators in quality improvement (including methods for safe management of head injuries by non-neurosurgeons in rural environments) and research in future phases of the long-term programme. THEME 2 - Understanding TBI care: Frameworks, stakeholders and critical issues This theme aims to develop an in-depth understanding of the challenges associated with improving TBI care, using a Systems Modelling approach. Initially, we intend to perform the majority of this work in Myanmar, a major recipient of UK Aid. Cambridge has an institutional health partnership with Yangon General Hospital (YGH) funded by the Tropical Health Education Trust (THET). This aims to improve systems of trauma care within YGH through educational activities, mentoring, academic research, and clinical exchange. As a result of the success of this partnership, we have been invited by the Myanmar Ministry of Health to perform a national survey of trauma intensive care
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