Scoping Review of the Published Guidelines for the Management of Traumatic Brachial Plexus Injuries

TL;DR

This study reviews existing guidelines for managing traumatic brachial plexus injuries and finds they lack comprehensive, structured recommendations, especially for low- and middle-income countries.

Contribution

The study identifies a gap in structured, consensus-based guidelines for traumatic brachial plexus injuries in resource-limited settings.

Findings

Eight guidelines were identified, but none provided a comprehensive management regimen for traumatic brachial plexus injuries.

Guidelines lacked a sequenced surgical approach and consistent outcome reporting.

No guidelines specifically address challenges in low- and middle-income countries.

Abstract

A traumatic brachial plexus injury (TBPI) is a rare yet debilitating condition with a typical incidence of 0.6-3.9 per 100000 annually, predominantly affecting young, economically active males following motorcycle accidents. Delayed diagnosis and treatment are associated with poorer functional outcomes, significant individual disability, and societal burdens, including loss of vocational potential and increased care costs. Individuals in resource-limited settings are particularly vulnerable to receiving suboptimal care. This study aimed to identify and evaluate existing published guidelines for the management of TBPI.

A systematic review of literature from nine medical databases, using standardized search methods with results screened for relevance and analyzed using modified Appraisal of Guidelines for Research and Evaluation II-global rating scale (AGREE II-GRS) guidelines to determine quality.

The search identified 1163 papers, of which eight met the inclusion criteria: six original research articles, one national guideline, and one departmental guideline. Six studies included treatment algorithms; however, only two categorized nerve transfers by pathology (upper (C5-6 ± C7), lower (C8-T1), or pan-plexus). None provided a sequenced or ordered approach to surgical management. Outcome reporting was inconsistent across studies. A modified AGREE II-GRS analysis indicated that the guidelines were appropriately targeted to relevant professional and patient groups.

At present, there are no TBPI guidelines with structured, consensus-based recommendations for managing this condition within acute or secondary care settings in low- and middle-income countries (LMICs). Our study identified eight published and accessible guidelines with treatment algorithms, but none provided a comprehensive management regimen covering all aspects of TBPI care. Developing such a guideline for LMICs is challenging due to the rarity, variability, and complexity of this pathology. Any guideline designed for this context must account for the health economics, resource availability, logistical barriers, and personnel constraints required to ensure a fit-for-purpose management plan for a TBPI service.

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