title: Design and validation of a critical pathway for hospital management of patients with severe traumatic brain injury.
abstract: BACKGROUND
  Critical pathways for the management of patients with severe traumatic brain injury (STBI) may contribute to reducing the incidence of hospital complications, length of hospitalization stay, and cost of care. Such pathways have previously been developed for departments with significant resource availability. In Mexico, STBI is the most important cause of complications and length of stay in neurotrauma services at public hospitals. Although current treatment is designed basically in accordance with the Brain Trauma Foundation guidelines, shortfalls in the availability of local resources make it difficult to comply with these standards, and no critical pathway is available that accords with the resources of public hospitals. The purpose of the present study was to design and to validate a critical pathway for managing STBI patients that would be suitable for implementation in neurotrauma departments of middle-income level countries.
  
  
  METHODS
  The study comprised two phases: design (through literature review and design plan) and validation (content, construct, and appearance) of the critical pathway.
  
  
  RESULTS
  The validated critical pathway for managing STBI patients entails four sequential subprocesses summarizing the hospital's care procedures, and includes three components: (1) nodes and criteria (in some cases, indicators are also included); (2) health team members in charge of the patient; (3) maximum estimated time for compliance with recommendations.
  
  
  CONCLUSIONS
  This validated critical pathway is based on the current scientific evidence and accords with the availability of resources of middle-income countries.
authors.affiliation: Neurosurgery Ward, Traumatology Hospital "Lomas Verdes", Mexico. amilcar.espinosa@imss.gob.mx
authors.forename: Amilcar
authors.initials: A
authors.lastname: Espinosa-Aguilar
authors.forename: Hortensia
authors.initials: H
authors.lastname: Reyes-Morales
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Huerta-Posada
authors.forename: Itzcoatl Limón-Pérez
authors.initials: IL
authors.lastname: de León
authors.forename: Fernando
authors.initials: F
authors.lastname: López-López
authors.forename: Margarita
authors.initials: M
authors.lastname: Mejía-Hernández
authors.forename: María A
authors.initials: MA
authors.lastname: Mondragón-Martínez
authors.forename: Ligia M
authors.initials: LM
authors.lastname: Calderón-Téllez
authors.forename: Rosa L
authors.initials: RL
authors.lastname: Amezcua-Cuevas
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Rebollar-González
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis / Q000628:therapy*; D019091:Critical Pathways / Q000458:organization & administration* / Q000592:standards; D003428:Cross Infection / Q000517:prevention & control; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D008800:Mexico