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Objectives: We evaluated treatment strategies for traumatic brain injury (TBI) management in both a high-income country (HIC) (University of Virginia Health System) and a low-income country setting (Kigali University Teaching Hospital). Methods: A review of the literature was performed to identify current strategies of TBI management in low and middle-income country (LMIC) settings. Additionally, personal communications with the neurosurgery and trauma teams at the University of Virginia (UVA) Medical Center and the Kigali University Teaching Hospital (KUTH) in Rwanda were employed. Results: At UVA, there are specific TBI treatment guidelines in place; however, these guidelines are somewhat resource intensive and might not be appropriate in a resource-limited setting. There are unpublished national neurosurgical guidelines that include sections on TBI management, but most physicians informally surveyed were unaware of the existence of these guidelines. Notably, a contextually relevant, institution-specific TBI guideline is in the process of being developed at KUTH. Conclusion: In an LMIC, such as Rwanda, interventions aimed at reducing the incidence of TBI, as well as predictive models to help allocate treatment resources, will likely help to improve outcomes in the short-term. Long-term improvement to provide outcomes similar to those seen in HIC will rely on increasing the supply of scarce resources, including trained neurosurgeons.

Challenges and Solutions for Traumatic Brain Injury Management in a Resource-Limited Environment: Example of a Public Referral Hospital in Rwanda