Article Text
Statistics from Altmetric.com
Summary box
Traumatic brain injury is a major global health issue and requires a functional health system to be optimally managed—often lacking in those low-income and middle-income countries where the burden of this disease is highest.
Clinical care is the emergent property of a complex, adaptive, sociotechnical system: generating improvements in care can benefit from a systems approach.
Systems Engineering can inform a systems approach to healthcare improvement, complementing more traditional improvement techniques.
A systems approach may be a valuable tool in trying to understand, and improve, the clinical care of patients with traumatic brain injury in low-income and middle-income settings.
The Global Burden of Diseases, Injuries and Risk Factors Study showed that in 2010 trauma accounted for 9% of the world’s deaths—around 5 million people—while also resulting in millions of non-fatal injuries with resultant disability. Around 90% of injury-related deaths occurred in low-income and middle-income countries (LMICs), which also saw the greatest rise in these injuries due to road traffic collisions.1 More recent global health estimates from WHO for 2015 show a similar picture.2 As a disease subtype, traumatic brain injury (TBI) is one of the most devastating, with clinical, societal and economic sequelae.3 It is also startlingly common with an estimated 50 million or more cases per year; enough for half of the world’s population to suffer a TBI in their lifetime and again disproportionately affecting lower-income regions.4
TBI is a heterogeneous condition, which can be difficult to both manage and prognosticate in even the best resourced settings and involves an array of prehospital, acute treatment and rehabilitation services.4 5 These are interdependent meaning improvement in any one area of care may not be reflected in overall clinical outcome. While aggressive treatment of TBI can minimise disability in many patients, prevention of mortality can also result in …