Comment on: Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP]) Journal of Neurosciences in Rural Practice 2020; 11(01): 007-022 DOI: 10.1055/s-0040-1701370 At the onset, I would like to congratulate the authors for development of guideline for management of traumatic brain injury (TBI) in a developing country. The Columbian guidelines presented in this article are applicable for most of the low- and low-middle–income countries worldwide.[1] One cannot generalize the American Brain Trauma Foundation/Scandinavian/The National Institute for Health and Care Excellence (NICE) guidelines for use in developing countries. There is a need of such guidelines which this article fulfills. There are some differences between Columbian guidelines and other international guidelines. One of them is transfer of patients with moderate-to-severe TBI. Such patients should be transferred immediately to a neurosurgical center for better outcome rather shifting to a nearest hospital without any facility. However, such patients are often transferred to a nearest hospital in many countries, as there is lack of trauma system. The transferring team is often unaware of the facilities available at the hospital where the patient is being transferred to. Even if the patient needs to be transferred to a neurosurgical center, it may not be feasible because of the distance and cost of transfer. Many patients with severe TBI do not reach in time to a definitive hospital, as they waste a lot of time by transporting from one hospital to another. In the nearest hospital, at least resuscitation and wound suturing can be done to prevent hypoxia, hypotension, and anemia due to hemorrhage before the patient reaches to the definite hospital. The Columbian guidelines have also defined algorithm for management of patient in a setup with or without intensive care (ICU). This is an important aspect of patient management. In most of the centers of developing countries, patients are often operated in smaller hospitals for head injury. They may then be transferred to an ICU depending on the requirement of postoperative care, as minimal setup is required for craniotomy but advanced setup is required for ICU patients. The development of guidelines is easy but its implementation and adherence is poor...
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