Paradigm shift: from standard-driven protocols to resource-driven guidelines for neurotrauma management in low-and middle-income countries

The project by Rubiano et al known as BOOTStraP ¹ is part of an effort toward provision of resource-stratified guidelines for the management of neurotrauma in low-resource settings. This article, which is aptly acronymed as “BOOTStraP,” is a landmark work by Rubiano et al, has combined evidence-based guidelines with consensus-based recommendations from experts in trauma management in general and neurotrauma management in particular. The current work stems out from the collaborative efforts of the Colombian Association of Neurosurgery, the World Federation of Neurosurgical Societies (WFNS), and the Global Health Research Group for Neurotrauma (GHRGN) of the National Institute of Health Research (NIHR). The BOOTStraP is a timely effort in the context of rising awareness of the dire situation of poor patient outcomes in low- and middle-income countries (LMICs), and we are sure that it will be of help in improving neurotrauma care in the LMICs. One of the unique features of the BOOTStraP is that it focuses on all aspects of the needs of different situations in management of neurotrauma, ranging from prevention to advanced neurointensive care for mild-to-severe TBI and TBI in polytrauma settings.