Multimodality Monitoring Consensus Statement: Monitoring in Emerging Economies
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REVIEW ARTICLE
Multimodality Monitoring Consensus Statement: Monitoring in Emerging Economies Anthony Figaji • Corina Puppo • The Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring
Springer Science+Business Media New York 2014
Abstract The burden of disease and so the need for care is often greater at hospitals in emerging economies. This is compounded by frequent restrictions in the delivery of good quality clinical care due to resource limitations. However, there is substantial heterogeneity in this economically defined group, such that advanced brain monitoring is routinely practiced at certain centers that have an interest in neurocritical care. It also must be recognized that significant heterogeneity in the delivery of neurocritical care exists even within individual highincome countries (HICs), determined by costs and level of interest. Direct comparisons of data between HICs and the group of low- and middle-income countries (LAMICs) are made difficult by differences in patient demographics, selection for ICU admission, therapies administered, and outcome assessment. Evidence suggests that potential benefits of multimodality monitoring depend on an appropriate environment and clinical expertise. There is no evidence to suggest that patients in LAMICs where such resources exist should be treated any differently to patients
The Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring are listed in ‘‘Appendix’’ section A. Figaji Division of Neurosurgery, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa A. Figaji (&) Red Cross Children’s Hospital, 617 ICH Building, Rondebosch, Cape Town 7700, South Africa e-mail: [email protected] C. Puppo Departamento de Emergencia, Hospital de Clı´nicas, Facultad de Medicina, Universidad de la Repu´blica, Montevideo, Uruguay
from HICs. The potential for outcome benefits in LAMICs is arguably greater in absolute terms because of the large burden of disease; however, the relative cost/benefit ratio of such monitoring in this setting must be viewed in context of the overall priorities in delivering health care at individual institutions. Keywords Neurocritical care Multimodality monitoring Low- and middle-income countries Developing countries Traumatic brain injury
Introduction The burden of disease from conditions that require neurocritical care is often greater in emerging economies, and outcomes are generally worse. For example, it is estimated that 90 % of trauma-related deaths occur in the developing world [1], Disability-Adjusted Life Years (DALYs) losses due to injury progressively rise with decreasing income levels [2], the odds of dying due to injury are higher, and the relative proportion of TBI in injury cases is greater in low-income settings [3]. Similarly, cerebral infections and the cerebral consequences of uncontrolled hypertension may place greater demand on intensive care units (ICU). Therefore, a global comm
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