Design and validation of a critical pathway for hospital management of patients with severe traumatic brain injury.
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.
Espinosa-Aguilar
Amilcar
A
Neurosurgery Ward, Traumatology Hospital "Lomas Verdes", Mexico. amilcar.espinosa@imss.gob.mx
Reyes-Morales
Hortensia
H
Huerta-Posada
Carlos E
CE
de León
Itzcoatl Limón-Pérez
IL
López-López
Fernando
F
Mejía-Hernández
Margarita
M
Mondragón-Martínez
María A
MA
Calderón-Téllez
Ligia M
LM
Amezcua-Cuevas
Rosa L
RL
Rebollar-González
Jorge A
JA
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