Strengthening neurotrauma care systems in low and middle income countries.

PRIMARY OBJECTIVE: To review basic elements to be considered in the development of effective neurotrauma care systems in low- and middle-income countries. Neurotrauma occurs more frequently in developing countries. The survival rate among neurotrauma patients depends in large part on the degree of sophistication of the trauma system. RESEARCH DESIGN: A critical review of the literature was undertaken. RESULTS: In developing countries, there are difficulties in fully integrating the resources for care if the local and regional trauma systems are poorly structured. Factors like inadequate emergency and neurointensive care, low compensation compared with elective procedures or high medico-legal risks may result in a lack of interest from the few available neurosurgeons to be fully integrated in neurotrauma care. Appropriate structuring of trauma systems according to countries needs and their functionality is a key element that would facilitate the optimal use of resources for integral neurotrauma care. CONCLUSIONS: In order to implement an efficient trauma system, organization of low cost resources such as trauma registries and quality control programmes are required. The participation of medical associations in legislative and government processes is also an important factor for the appropriate development and organization of an effective trauma system in under-privileged areas.