Algorithms for the Diagnosis and Treatment of Severe Traumatic Brain Injury in One Low Income Country

Severe traumatic brain injury is a leading cause of death and disability worldwide. The optimal role of invasive intracranial pressure and cerebral perfusion pressure monitoring compared with non‑invasive clinical and imaging‑based management remains uncertain, particularly in low‑resource settings. The objective of this study was to design and evaluate new diagnostic and treatment algorithms for adult patients with severe TBI. A quasi‑experimental study was carried out between January 2010 and December 2024. Patients were assigned to two groups: Group I received continuous invasive ICP and CPP monitoring together with clinical and CT monitoring; Group II received only clinical and CT monitoring. The primary outcome was functional status at one-year post‑discharge according to the Glasgow Outcome Scale (GOS). A total of 250 patients were included: 145 (58%) in Group I and 105 (42%) in Group II. In Group I, the most frequent outcome was GOS V (good recovery), whereas in Group II, GOS I (death) predominated. Satisfactory recovery was achieved in 104/145 patients (71.72%) in Group I vs. 65/105 (61.90%) in Group II. Mortality was 39/145 (26.9%) in Group I vs. 44/105 (41.9%) in Group II (difference 15.0 percentage points; p ≤ 0.05). Continuous invasive ICP and CPP monitoring, was associated with significantly lower mortality and higher rates of satisfactory recovery compared with clinical and imaging‑based management alone. These findings support the use of invasive neuromonitoring where resources permit, while the non‑invasive algorithm may serve as an alternative in low‑resource settings.