title: Neurotrauma outside the high-income setting: a review of audit and data-collection strategies.
abstract: OBJECTIVE
  To review the sparse literature that exists on the topic of head injury assessment and management outside high-income settings and attempt to: 1) identify strengths and weaknesses of the currently published clinical data relating to head injuries in lower-income countries; and 2) consider specific objectives for future head injury research in the resource-limited setting. If levels of excellence in neurosurgery are to be sustainably achieved outside high-income countries, there must be good systems of research and audit in place both to identify where development is needed and to evaluate the efficacy of development projects already in progress.
  
  
  METHODS
  We performed a MEDLINE search of publications between 1980 and 2010 by using the search terms head injuries/craniocerebral trauma/neurotrauma and developing world/developing nations. Information was extracted and compared between publications by using our local head injury evaluation and audit database (OxHEAD) as a quality standard.
  
  
  RESULTS
  The issue of traumatic brain injury management in low-income countries is underrepresented in the international literature relative to the scale of the problem. However, epidemiologic data generally are better reported than data relating to in-hospital care and follow-up, which suffers as a result of heterogeneous data collection and categorization techniques.
  
  
  CONCLUSIONS
  The use of standardized scoring systems and outcome measures is likely to improve the comparability of data between studies. A multicenter collaborative approach towards data collection in resource-limited settings may be the most efficient and productive strategy for future research.
authors.affiliation: Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom. holly.sitsapesan@gmail.com
authors.forename: Holly A
authors.initials: HA
authors.lastname: Sitsapesan
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Lawrence
authors.forename: Clare
authors.initials: C
authors.lastname: Sweasey
authors.forename: Knut
authors.initials: K
authors.lastname: Wester
mesh_terms: D001930:Brain Injuries / Q000453:epidemiology / Q000628:therapy; D019090:Case Management; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy; D003906:Developing Countries; D005500:Follow-Up Studies; D005843:Geography; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D007182:Income; D009493:Neurosurgery / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D020196:Trauma, Nervous System / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy*