Association of protocol-driven care with complication rates in severe traumatic brain injury: a two-hospital quasi-experimental study in a resource-limited setting

Objective To evaluate the impact of implementing Brain Trauma Foundation (BTF) guidelines on complication rates and clinical outcomes in severe traumatic brain injury (STBI) in a resource-limited setting.Methods A quasi-experimental study (n = 70) was conducted in a resource-limited setting. Control group (n = 35) received routine care; study group (n = 35) was managed according to BTF guidelines. Complications (fever, pressure ulcers, hyperglycemia, infection, increased ICP) were collected daily. Outcomes included complication rates/severity, ventilation days, ICU stay, and Glasgow Outcome Scale Extended (GOSE).Results The study group had significantly lower complication rates: fever (37.1% vs. 62.9%, p = 0.055), bed sores (5.7% vs. 31.4%, p = 0.0065), hyperglycemia (31.4% vs. 57.1%, p = 0.05), infection (20.0% vs. 51.4%, p = 0.01), and increased ICP (11.4% vs. 42.9%, p = 0.006). Mean complications per patient were lower (1.9 ± 1.2 vs. 2.8 ± 1.5, p = 0.006). Early surgery (48–72 h) was associated with lower complication rates. Complication occurrence strongly predicted unfavorable outcomes.Conclusions Implementing BTF guidelines was associated with lower complication incidence and severity in STBI patients in a resource-limited setting. Protocol-driven care and early surgery were associated with fewer complications, which strongly predicted better functional outcomes.However, because the intervention and control groups were treated at different hospitals with differing resources, these findings should be interpreted as hypothesis-generating rather than causal.