(1751) A Needs Assessment for Pediatric Traumatic Brain Injury Management in Resource-Limited Settings

Introduction: Childhood injuries are the leading cause of death in children older than 1 year, and of those, traumatic brain injury (TBI) is mostly likely to result in death, permanent disability, or interruption in normal child development. Children from lower socioeconomic backgrounds experience a higher rate of TBI, and most pediatric TBI occur in low middle income countries (LMICs). A vast disparity exists between outcomes in LMICs and high-income countries given distinct health care systems and resource availability. We performed an initial needs assessment to identify current pre- and in-hospital TBI interventions and perceived barriers to providing optimal care for pediatric TBI patients in LMICs.

Methods: We conducted a descriptive, cross-sectional study across healthcare facilities in limited resource settings as defined by the Global Burden of Disease Super Regions (excluding High Income) over 6 months. Descriptive analysis was used to summarize provider responses.

Results: Physicians from Colombia, Ghana, Nigeria, Rwanda, and South Africa responded to the survey. Seventy-one percent of responders work at a tertiary medical center; of those, 80% are at a designated trauma center. While most (86%) facilities have a pediatric intensive care unit, the majority (57%) do not have a protocol for managing moderate to severe TBI. Fifty-seven percent of facilities have reliable access to trained personnel and equipment for peripheral IV insertion and endotracheal intubation. While all facilities have access to a CT machine and a neurosurgeon, only 57% have access to a pediatric neurosurgeon and 43% can reliably monitor intracranial pressure. All facilities have access to mannitol; 71% have access to hypertonic saline and 71% of responders use hyperosmolar therapy. All responders have skills in bag mask ventilation and access to endotracheal tubes, yet only 29% use hyperventilation to manage moderate to severe TBI.

Conclusions: Preliminary data shows that there are common barriers to caring for pediatric TBI patients in LMICs, providing an opportunity to create a protocol that can be reproducible in low resource settings in an effort to reduce mortality and morbidity. Future studies are needed to develop low-cost and low resource-utilization interventions to improve pediatric TBI management in LMICs.