Priorities and Concerns for Research on Neurotrauma in the Developing World.

Neurotrauma, including cranial and spinal injuries, is a major health issue in both the developing and developed world. The incidence of traumatic brain injuries varies from 91 to 430 per 100,000 people, involving the younger active subpopulation of the societies [1]. Despite being a major cause of morbidity and mortality, neurotrauma is to a great extent preventable. The incidence of neurotrauma is expectedly higher in the developing nations with lower income [1], and nevertheless, the epidemiology and etiology are significantly different as compared to those of the developed world. The rapid industrial and economic growth in developing countries has resulted in an enormous increase in the number of motorcycles and motor-vehicle accidents, which is probably the most common cause of neurotrauma in most developing countries [2]. The patient population, genetics, environment and habits may also be extremely different. Management strategies and access to necessary sophisticated resources are variable and in most settings deficient. Despite these significant discrepancies, most standards and guidelines in the literature have been proposed by the authors in high-income countries from well-resourced neurosurgical centers [3], which represent a different epidemiology and etiology as compared to those of developing nations. Therefore, design and performance of epidemiological and clinical studies seems crucial for delineating these differences and establishment of more effective strategies for patient management in developing countries. One valuable area of research on neurotrauma is prevention. The available data on the epidemiology of neurotrauma in developed societies may not necessarily help in establishing preventive strategies in developing nations. Important legislations mandating the use of helmets for motorcyclists, strict road-traffic regulations, and development of better road constructions are the results of epidemiological studies in this area. There is for sure need for more comprehensive studies. A major baseline step in establishment of goal research projects in the field of neurotrauma is to institute comprehensive patient registries. Institutional or nationwide registries are valuable tools for data collection and further study design, which are currently lacking in many centers in developing countries. One useful review [4] on the data collection strategies in developing nations concludes that neurotrauma is underrepresented in the international literature relative to the scale of the