# Development and Validation of a Neuro-Intensive Care Protocol for Traumatic Brain Injury Management

## TL;DR

This study created and validated a detailed protocol for managing traumatic brain injuries in intensive care, aiming to improve patient outcomes globally.

## Contribution

The novel contribution is the development and expert validation of the NICP-TBI protocol using a structured consensus method.

## Key findings

- The NICP-TBI protocol achieved 99.2% consensus among experts after five Delphi rounds.
- The protocol has a tiered structure suitable for resource-limited settings and includes comprehensive treatment goals.
- Expert validation confirmed the protocol's high content validity with a CVI of 1.

## Abstract

Introduction

Traumatic brain injury (TBI) is a global public health concern with high mortality and disability rates, particularly among younger populations. Structured treatment protocols might improve outcomes and reduce mortality. This study aims to develop and validate the Neuro-Intensive Care Protocol for TBI (NICP-TBI) using the Medical Research Council framework for designing and evaluating complex interventions.

Methods

The protocol was developed using a systematic literature review, expert consensus, and validation. A 15-member multidisciplinary expert consensus group used the Delphi consensus method to refine the protocol, achieving a consensus threshold of 80%. Validation involved a seven-member expert group evaluating the protocol’s relevance, clarity, comprehensiveness, and appropriateness using a five-point Likert scale. The Content Validity Index (CVI) was calculated.

Results

The NICP-TBI incorporated interventions from clinical practice guidelines and evidence-based protocols. It established clear treatment goals and interventions for each parameter concerned such as airway, ventilation, systemic and cerebral perfusion, intracranial pressure (ICP), sedation, seizure prophylaxis, fluid management, nutrition, infection prophylaxis, temperature management, venous thromboembolism (VTE), blood glucose management, positioning, tapering treatment and family involvement in care. The protocol used a tiered structure adaptable to resource-limited settings. The Delphi process reached a 99.2% final consensus after five rounds, and the CVI was determined to be 1, confirming high validity.

Conclusions

The NICP-TBI provides a structured, evidence-based framework for managing moderate and severe TBI. The protocol’s consensus-driven development, tiered approach in management, and expert validation ensure its applicability across diverse clinical settings, including resource-limited environments. This study highlights the importance of expert consensus and validation in developing effective critical care protocols.