The Role of Electronic Medical Records in Enhancing Protocol Adherence and Outcomes for Traumatic Brain Injury in Low- and Middle-income Countries: A Systematic Review of Neurocritical Care Management
Caleigh Roach1, Matthew Kis2, Mikhail Marasigan2, Eugenio Reina2, Brett Weiss2, Ansh Bhatt2, Alan Ho1, Harini Adivikolanu2, Jacob Shawwa1, Joyce Kaufman M.D.3
1Department of Neurological Surgery, Miller School of Medicine, 2Miller School of Medicine, 3Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami
Objective:
This systematic review evaluates the role of Electronic Medical Records (EMR) in enhancing evidence-based protocols and improving the prognosis for traumatic brain injury (TBI) patients in low- and middle-income countries (LMICs).
Background:
TBI is a leading global cause of morbidity and mortality, disproportionately affecting LMICs. Prehospital care and timely emergency department interventions are crucial, yet LMICs often lack standardized treatment guidelines, EMR systems, and reliable internet infrastructure. This systematic review applies Haddon’s Matrix to examine post-injury interventions, evaluating how evidence-based protocols can reduce variability in care delivery and improve patient outcomes.
Design/Methods:
A dual-phase systematic review was conducted using PRISMA 2020 guidelines. Phase I evaluated (n=33) studies conducted at LMIC hospital systems, focusing on clinical decision-making and patient outcomes. These studies informed Phase II (n=26), which assessed EMR capacity and treatment guidelines by region, allowing for integrated data analysis. Descriptive statistics, chi-square (x²) tests, ANOVA, and multiple linear regression (MLR) assessed the relationship between EMR presence and outcomes.
Results:
Presence of EMR infrastructure demonstrated significant improvement in clinical outcomes, accounting for 36.5% of the variance in patient morbidity (p=0.0328, R²=0.3649). In regions with established EMR systems, ANOVA revealed a 12.17% morbidity reduction (F=4.7354, p=0.0328). Chi-square analysis showed strong associations between EMR presence and adherence to neurocritical care protocols, including airway management (p=0.0277, x²=4.72) and cervical spine immobilization (p<0.0001, x²=19.67). Low-EMR regions exhibited significant underutilization of computed tomography (CT) imaging (p=0.0142, x²=6.03) and seizure prophylaxis (p=0.0557, x²=3.78). Adherence to interventions led to a 16.73% improvement in patient survival (p=0.0222), with EMR presence contributing 46% to overall reduction in traumatic brain injury (TBI) mortality (R²=0.598, p=0.0282).
Conclusions:
EMR infrastructure strengthens neurocritical care interventions and leads to improved clinical outcomes in LMICs. These findings emphasize the need for global initiatives to prioritize EMR implementation and adopt evidence-based standards of care to reduce healthcare disparities in resource-limited settings.
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