Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries

Document Type : Review Article


1 Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

2 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA

3 Technical University of Munich, Munich, Germany

4 Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA

5 School of Medicine, University of Glasgow, Glasgow, UK

6 Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA


Injury is a major global health problem, causing >5 800 000 deaths annually and widespread disability largely attributable to neurotrauma. 89% of trauma deaths occur in low- and middle-income countries (LMICs), however data on neurotrauma epidemiology in LMICs is lacking. In order to support neurotrauma surveillance efforts, we present a review and analysis of data dictionaries from national registries in LMICs.

We performed a scoping review to identify existing national trauma registries for all LMICs. Inclusion/exclusion criteria included articles published since 1991 describing national registry neurotrauma data capture methods in LMICs. Data sources included PubMed and Google Scholar using the terms “trauma/neurotrauma registry” and country name. Resulting registries were analyzed for neurotrauma-specific data dictionaries. These findings were augmented by data from direct contact of neurotrauma organizations, health ministries, and key informants from a convenience sample. These data were then compared to the World Health Organization (WHO) minimum dataset for injury (MDI) from the international registry for trauma and emergency care (IRTEC).

We identified 15 LMICs with 16 total national trauma registries tracking neurotrauma-specific data elements. Among these, Cameroon had the highest concordance with the MDI, followed by Colombia, Iran, Myanmar and Thailand. The MDI elements least often found in the data dictionaries included helmet use, and alcohol level. Data dictionaries differed significantly among LMICs. Common elements included Glasgow Coma Score, mechanism of injury, anatomical site of injury and injury severity scores. Limitations included low response rate in direct contact methods.

Significant heterogeneity was observed between the neurotrauma data dictionaries, as well as a spectrum of concordance or discordance with the MDI. Findings offer a contextually relevant menu of possible neurotrauma data elements that LMICs can consider tracking nationally to enhance neurotrauma surveillance and care systems. Standardization of nationwide neurotrauma data collection can facilitate international comparisons and bidirectional learning among healthcare governments.



Commentaries Published on this Paper


  • Neurotrauma Registries in Low- and Middle-Income Countries for Building Organized Neurotrauma Care: The LATINO Registry Experience; Comment on “Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries”

        Abstract | PDF


  • Global Neurotrauma Surveillance: Are National Databases Overrated?; Comment on “Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries”

        Abstract | PDF


  • Towards Improved Organizational Governance of Neurotrauma Surveillance; Comment on “Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries”

        Abstract | PDF


  • The Role of Registries in Neurotrauma Research: Translating Data Into Health Policy That Enhances Patient Care; Comment on “Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries”

        Abstract | PDF


  • National Trauma Registries in LMICs: Long-Overdue Priority; Comment on “Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries”

        Abstract | PDF


  • National Neurotrauma Registry Data in Low- and Middle-Income Countries – Current Status and Future Requirements; Comment on “Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries”

        Abstract | PDF


Authors' Response to the Commentaries


  • Advancing Global Neurotrauma Surveillance Through National Registries: A Response to Recent Commentaries

        Abstract | PDF



  1. Haagsma JA, Graetz N, Bolliger I, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev. 2016;22(1):3-18. doi:1136/injuryprev-2015-041616
  2. Horton R. GBD 2010: understanding disease, injury, and risk. Lancet. 2012;380(9859):2053-2054. doi:1016/s0140-6736(12)62133-3
  3. World Health Organization (WHO). Injuries and Violence: The Facts 2014. WHO; 2014.
  4. World Health Organization (WHO). Injuries and Violence: The Facts 2014. WHO; 2014.
  5. de Lotbiniere-Bassett MP, McDonald PJ. Industry financial relationships in neurosurgery in 2015: analysis of the Sunshine Act Open Payments Database. World Neurosurg. 2018;114:e920-e925. doi:1016/j.wneu.2018.03.116
  6. Dewan MC, Rattani A, Gupta S, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018:130(4):1080-1097. doi:3171/2017.10.jns17352
  7. Corley J, Lepard J, Barthélemy E, Ashby JL, Park KB. Essential neurosurgical workforce needed to address neurotrauma in low- and middle-income countries. World Neurosurg. 2019;123:295-299. doi:1016/j.wneu.2018.12.042
  8. Nsubuga P, White ME, Thacker SB, et al. Public health surveillance: a tool for targeting and monitoring interventions. In: Jamison DT, Breman JG, Measham AR, et al, eds. Disease Control Priorities in Developing Countries. 2nd ed. Washington, DC: The International Bank for Reconstruction and Development, The World Bank; 2006:997-1018.
  9. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141-146. doi:1097/xeb.0000000000000050
  10. James SL, Theadom A, Ellenbogen RG, et al. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(1):56-87. doi:1016/s1474-4422(18)30415-0
  11. de Araújo Andrade SS, de Mello Jorge MH. Estimate of physical sequelae in victims of road traffic accidents hospitalized in the Public Health System. Rev Bras Epidemiol. 2016;19(1):100-111. doi:1590/1980-5497201600010009
  12. de Almeida CE, de Sousa Filho JL, Dourado JC, Gontijo PA, Dellaretti MA, Costa BS. Traumatic brain injury epidemiology in Brazil. World Neurosurg. 2016;87:540-547. doi:1016/j.wneu.2015.10.020
  13. Li Y, Chen F, Zhang J, et al. Epidemiological characteristics of Chinese paediatric traumatic brain injury inpatients. Brain Inj. 2017;31(8):1094-1101. doi:1080/02699052.2017.1298004
  14. Liu P, Yao Y, Liu MY, et al. Spinal trauma in mainland China from 2001 to 2007: an epidemiological study based on a nationwide database. Spine (Phila Pa 1976). 2012;37(15):1310-1315. doi:1097/BRS.0b013e3182474d8b
  15. Fitzharris M, Zhong W, Myburgh J, et al. The status of trauma registry systems in Chinese hospitals. Inj Prev. 2011;17(6):419-421. doi:1136/injuryprev-2011-040216
  16. Kool B, Raj N, Wainiqolo I, Kafoa B, McCaig E, Ameratunga S. Hospitalised and fatal head injuries in Viti Levu, Fiji: findings from an island-wide trauma registry (TRIP 4). Neuroepidemiology. 2012;38(3):179-185. doi:1159/000337261
  17. Wainiqolo I, Kafoa B, Kool B, Herman J, McCaig E, Ameratunga S. A profile of injury in Fiji: findings from a population-based injury surveillance system (TRIP-10). BMC Public Health. 2012;12:1074. doi:1186/1471-2458-12-1074
  18. Wainiqolo I, Kafoa B, McCaig E, Kool B, McIntyre R, Ameratunga S. Development and piloting of the Fiji injury surveillance in hospitals system (TRIP Project-1). Injury. 2013;44(1):126-131. doi:1016/j.injury.2011.10.007
  19. Haghparast-Bidgoli H, Saadat S, Bogg L, Yarmohammadian MH, Hasselberg M. Factors affecting hospital length of stay and hospital charges associated with road traffic-related injuries in Iran. BMC Health Serv Res. 2013;13:281. doi:1186/1472-6963-13-281
  20. Naghdi K, Azadmanjir Z, Saadat S, et al. Feasibility and data quality of the National Spinal Cord Injury Registry of Iran (NSCIR-IR): a pilot study. Arch Iran Med. 2017;20(8):494-502.
  21. Saadat S, Eslami V, Rahimi-Movaghar V. The incidence of peripheral nerve injury in trauma patients in Iran. Ulus Travma Acil Cerrahi Derg. 2011;17(6):539-544. doi:5505/tjtes.2011.75735
  22. Saadat S, Rashidi-Ranjbar N, Rasouli MR, Rahimi-Movaghar V. Pattern of skull fracture in Iran: report of the Iran National Trauma Project. Ulus Travma Acil Cerrahi Derg. 2011;17(2):149-151. doi:5505/tjtes.2011.26043
  23. Heidari P, Zarei MR, Rasouli MR, Vaccaro AR, Rahimi-Movaghar V. Spinal fractures resulting from traumatic injuries. Chin J Traumatol. 2010;13(1):3-9.
  24. Ward E, Arscott-Mills S, Gordon G, Ashley D, McCartney T. The establishment of a Jamaican all-injury surveillance system. Inj Control Saf Promot. 2002;9(4):219-225. doi:1076/icsp.
  25. Crandon IW, Harding-Goldson HE, Benaris M, McDonald AH. Unnecessary admissions of head-injured patients at the University Hospital of the West Indies. West Indian Med J. 2007;56(3):226-229. doi:1590/s0043-31442007000300006
  26. Sabariah FJ, Ramesh N, Mahathar AW. National Trauma Database (NTrD)--improving trauma care: first year report. Med J Malaysia. 2008;63 Suppl C:45-49.
  27. Puvanachandra P, Hoe C, El-Sayed HF, et al. Road traffic injuries and data systems in Egypt: addressing the challenges. Traffic Inj Prev. 2012;13 Suppl 1:44-56. doi:1080/15389588.2011.639417
  28. Atiq H, Siddiqui E, Bano S, et al. The pediatric disease spectrum in emergency departments across Pakistan: data from a pilot surveillance system. BMC Emerg Med. 2015;15 Suppl 2:S11. doi:1186/1471-227x-15-s2-s11
  29. Enumah S, Scott JW, Maine R, et al. Rwanda's model prehospital emergency care service: a two-year review of patient demographics and injury patterns in Kigali. Prehosp Disaster Med. 2016;31(6):614-620. doi:1017/s1049023x16000807
  30. Muro-Báez VA, Mendoza-García ME, Vera-López JD, Pérez-Núñez R. [Analysis of road traffic injuries in Mexican cyclists]. Gac Med Mex. 2017;153(6):653-661. doi:24875/gmm.17002632
  31. Juillard CJ, Stevens KA, Monono ME, et al. Analysis of prospective trauma registry data in Francophone Africa: a pilot study from Cameroon. World J Surg. 2014;38(10):2534-2542. doi:10.1007/s00268-014-2604-1
  32. Duan L, Deng X, Wang Y, et al. The national injury surveillance system in China: a six-year review. Injury. 2015;46(4):572-579. doi:1016/j.injury.2014.12.013
  33. National Programme for Prevention and Management of Trauma and Burn Injuries. Accessed November 2021.
  34. National Trauma Database and Clinical Research Centre MoH, Malaysia. National Trauma Database January 2009 to December 2009, Fourth Report. 2009.
  35. Injury Prevention Project DoH, Ministry of Health, Myanmar. Injury Surveillance Report 2010-2013.
  36. Mir M, Bachani AM, Khawaja H, et al. The Pakistan National Emergency Department Surveillance Study (Pak-NEDS): Introducing a pilot surveillance. BMC Emerg Med. 2015;15 Suppl 2:S1. doi:1186/1471-227x-15-s2-s1
  37. World Health Organization. Intercountry Workshop on Injury Surveillance: A Report, Bandos, Maldives, 28-30 April 2009. WHO Regional Office for South-East Asia; 2010.
  38. Fuller G, Bouamra O, Woodford M, et al. Temporal trends in head injury outcomes from 2003 to 2009 in England and Wales. Br J Neurosurg. 2011;25(3):414-421. doi:3109/02688697.2011.570882
  39. Marincowitz C, Lecky FE, Townend W, Allgar V, Fabbri A, Sheldon TA. A protocol for the development of a prediction model in mild traumatic brain injury with CT scan abnormality: which patients are safe for discharge? Diagn Progn Res. 2018;2:6. doi:1186/s41512-018-0027-4
  40. Marincowitz C, Lecky FE, Townend W, Borakati A, Fabbri A, Sheldon TA. The risk of deterioration in GCS13-15 patients with traumatic brain injury identified by computed tomography imaging: a systematic review and meta-analysis. J Neurotrauma. 2018;35(5):703-718. doi:1089/neu.2017.5259
  41. Dewan MC, Rattani A, Fieggen G, et al. Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change. J Neurosurg. 2018;130(4):1055-1064. doi:3171/2017.11.jns171500
  42. Barthélemy EJ, Park KB, Johnson W. Neurosurgery and sustainable development goals. World Neurosurg. 2018;120:143-152. doi:1016/j.wneu.2018.08.070
  43. Kesinger MR, Nagy LR, Sequeira DJ, Charry JD, Puyana JC, Rubiano AM. A standardized trauma care protocol decreased in-hospital mortality of patients with severe traumatic brain injury at a teaching hospital in a middle-income country. Injury. 2014;45(9):1350-1354. doi:1016/j.injury.2014.04.037
  44. Rubiano AM, Carney N, Chesnut R, Puyana JC. Global neurotrauma research challenges and opportunities. Nature. 2015;527(7578):S193-197. doi:1038/nature16035
  45. St-Louis E, Paradis T, Landry T, Poenaru D. Factors contributing to successful trauma registry implementation in low- and middle-income countries: a systematic review. Injury. 2018;49(12):2100-2110. doi:1016/j.injury.2018.10.007
  46. Escobar AM, Sanchez AI, Puyana JC, Fabio A, Adelson PD. The Colombian Neurotrauma Consortium: a pilot project for TBI registry in a low-middle income country. J Neurotrauma. 2008;25(7):873-873.
  47. World Health Organization (WHO). WHO Dataset for Injury. WHO; 2020.
  48. Mirani N, Ayatollahi H, Khorasani-Zavareh D. Injury surveillance information system: a review of the system requirements. Chin J Traumatol. 2020;23(3):168-175. doi:1016/j.cjtee.2020.04.001
  49. Jafar AJN, Sergeant JC, Lecky F. What is the inter-rater agreement of injury classification using the WHO minimum data set for emergency medical teams? Emerg Med J. 2020;37(2):58-64. doi:1136/emermed-2019-209012
  50. World Health Organization (WHO). WHO International Registry for Trauma and Emergency Care. WHO; 2020.
  51. Dijkink S, Nederpelt CJ, Krijnen P, Velmahos GC, Schipper IB. Trauma systems around the world: a systematic overview. J Trauma Acute Care Surg. 2017;83(5):917-925. doi:1097/ta.0000000000001633
  52. Mitchell RJ, Williamson AM, O'Connor R. The development of an evaluation framework for injury surveillance systems. BMC Public Health. 2009;9:260. doi:1186/1471-2458-9-260
  53. Mehmood A, Zia N, Hoe C, Kobusingye O, Ssenyojo H, Hyder AA. Traumatic brain injury in Uganda: exploring the use of a hospital based registry for measuring burden and outcomes. BMC Res Notes. 2018;11(1):299. doi:1186/s13104-018-3419-1
  54. Thurman DJ, Kraus JF, Romer CJ. Standards for Surveillance of Neurotrauma. Geneva, Switzerland: World Health Organization; 1995.
  55. Maas AI, Harrison-Felix CL, Menon D, et al. Standardizing data collection in traumatic brain injury. J Neurotrauma. 2011;28(2):177-187. doi:1089/neu.2010.1617
Volume 11, Issue 11
November 2022
Pages 2373-2380
  • Receive Date: 08 March 2021
  • Revise Date: 10 November 2021
  • Accept Date: 05 December 2021
  • First Publish Date: 06 December 2021