Evidence map›Paper›PMID 39920547›Full record

ArticleNeurocritical care2025

Neurocritical Care Organization in the Low-Income and Middle-Income Countries.

Hemanshu Prabhakar, Abhijit V Lele, Indu Kapoor, Charu Mahajan, Gentle S Shrestha, Chethan Venkatasubba Rao, Jose I Suarez, Sarah L Livesay, Faraz Shafiq, Konstantin Popugaev and 37 more

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Article in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

47 authors.

Hemanshu Prabhakar *Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India. prabhakaraiims@yahoo.co.in.ORCID 0000-0001-7830-3296
Abhijit V Lele *Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Indu KapoorDepartment of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Charu MahajanDepartment of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Gentle S ShresthaDepartment of Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Chethan Venkatasubba RaoDepartments of Neurology and Neurosurgery and Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA.
Jose I SuarezDivision of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Sarah L LivesayDepartment of Adult and Gerontological Nursing, Rush University, Chicago, IL, USA.
Faraz ShafiqDepartment of Anaesthesiology, The Aga Khan University, Karachi, Pakistan.
Konstantin PopugaevAnaesthesia and Intensive Care, Burnazian State Research Centre, Moscow, Russia.
Dhania SantosaDepartment of Anesthesiology and Reanimation, Dr Soetomo General Academic Hospital, Surabaya, Indonesia.
Obaidullah Naby ZadaDepartment of Anesthesia, French Medical Institute for Mothers and Children, Kabul, Afghanistan.
Wanning YangDepartment of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Hosne Ara NishaSquare Hospital Limited, Dhaka, Bangladesh.
Julio C Mijangos-MendezDepartment of Medical Clinics, University Centre for Health Sciences, University of Guadalajara, Guadalajara, Mexico.
Peter Kaahwa AgabaDepartment of Anaesthesia and Intensive Care, Mulago National Superspecialized Referral Hospital, Kampala, Uganda.
Juan Luis Pinedo PortillaDepartment of Emergency and Critical Care, Almanzor Aguinaga Asenjo Hospital, Chiclayo, Peru.
Yalew Hasen TuahirDebre Tabor University, Debra Tabor, Ethiopia.
Puvanendiran ShanmugamIntensive Care Unit, Peradeniya Teaching Hospital, Peradeniya, Sri Lanka.
Yanet Pina ArruebarrenaIntensive Care Unit Department, Greater Accra Regional Hospital, Accra, Ghana.
Walter VidettaDepartment of Intensive Care, Posadas Hospital, Buenos Aires, Argentina.
Sebastián Vásquez-GarcíaNeurosciences and Intensive Care Department, Clínica del Country, Bogotá, Colombia.
M Samy Abdel RaheemDepartment of Anaesthesiology and Intensive Care, Asyut University Hospitals, Asyût, Egypt.
Fasika YimerDepartment of Medical Sciences, Hage Geingob Campus School of Medicine, University of Namibia, Windhoek, Namibia.
Llewellyn C PadayachyBrain Tumor and Translational Neuroscience Centre, Department of Neurosurgery, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.
Luis Silva NaranjoIntensive Care Unit, Hospital General Ambato, Ambato, Ecuador.
Pedro ArriagaCritical Care, Karl Heusner Memorial Hospital, Belize City, Belize.
Chann MyeiDepartment of Anaesthesia and Intensive Care, Defence Services General Hospital, Yangon, Myanmar.
Sarah Shali MatujaDepartment of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Tarig FadallaDepartment of Neurosurgery, Soba University Hospital, Khartoum, Sudan.
Tanuwong ViarasilpaDivision of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Ganbold LundegDepartment of Critical Care and Anaesthesia, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
Halima M Salisu-KabaraAnesthesiology/Intensive Care Unit/Theatres, Aminu Kano Teaching Hospital, Kano, Nigeria.
Samuel Ern Hung TsanDepartment of Anaesthesiology and Intensive Care, Faculty of Medicine and Health Sciences, University of Malaysia, Sarawak, Malaysia.
Simon P GutierrezIntensive Care, Hospital de Especialidades Materno Infantile, La Paz, Bolivia.
Leroy P YankaeDepartment of Neurology, University Teaching Hospitals, Lusaka, Zambia.
Aidos KonkayevDepartment of Anesthesia and Intensive Care, Astana Medical University, Astana, Kazakhstan.
Nophanan ChaikittisilpaDepartment of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol, Bangkok, Thailand.
Gisele SampaioDepartment of Neurology, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paulo, Brazil.
Tuan Van BuiNeurosurgical Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Vietnam.
Geraldine Seina L MarianoCritical Care Services, St. Luke's Medical Centre, Quezon City, Philippines.
Gisselle Aguilar SabillonHospital Mario Catarino Rivas, San Pedro Sula, Honduras.
Pablo BlancoHospital Dr Luis Razetti, Barcelona, Anzoátegui, Venezuela.
Williams OrtizHospital Ingavi, San Lorenzo, Paraguay.
Angel Jesus Lacerda GallardoHospital General Docente Roberto Rodríguez Fernández, Morón, Cuba.
Oguzhan ArunDepartment of Anesthesiology and Reanimation, Faculty of Medicine, Selcuk University, Konya, Turkey.
Kalaivani ManiDepartment of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThis study aimed to assess the organization, infrastructure, workforce, and adherence to protocols in neurocritical care across low- and middle-income countries (LMICs), with the goal of identifying key gaps and opportunities for improvement.

methodsWe conducted a cross-sectional survey of 408 health care providers from 42 LMICs. The survey collected data on the presence of dedicated neurointensive care units, workforce composition, access to critical care technologies, and adherence to evidence-based protocols. Data were analyzed using descriptive statistics, and comparisons were made across different geographical regions (East Asia and the Pacific, Europe and Central Asia, Latin America and the Caribbean, the Middle East and North Africa, and South Asia and sub-Saharan Africa) and economic strata [low-income countries (LICs), lower middle-income countries (LoMICs), and upper middle-income countries (UMICs)].

resultsOnly 36.8% of respondents reported access to dedicated neurointensive care units: highest in the Middle East (100%), lowest in sub-Saharan Africa (11.5%), highest in LoMICs (42%), and lowest in LICs (13%). Access to critical care technologies, such as portable computed tomography scanners (9.3%; UMICs 11%, LICs 0%) and tele-intensive care unit services (14.9%; UMICs 19%, LICs 10%), was limited. Workforce shortages were evident, with many institutions relying on anesthesia residents for 24-h care. Adherence to protocols, including those for acute ischemic stroke (61.7%) and traumatic brain injury (55.6%), was highest in Latin America and the Caribbean (72% and 73%, respectively) and higher in UMICs (66% and 60%, respectively) but remained low in LICs (22% and 32%, respectively).

conclusionsThe study highlights critical gaps in infrastructure, workforce, and technology across LMICs, yet it also underscores the potential for improvement. Strategic investments in neurointensive care unit capacity, workforce development, and affordable technologies are an unmet need in resource-limited settings. These findings offer a road map for policymakers and global health stakeholders to prioritize neurocritical care and reduce the disparities in patient outcomes globally.

Indexed as

Critical CareDeveloping CountriesGuideline AdherenceHealth Services AccessibilityIntensive Care UnitsCross-Sectional StudiesHealth PersonnelHealth WorkforceHumansIntensive care unitLow-income countriesMiddle-income countriesNeurocritical careOrganizationProtocols

Identifiers

PMID39920547

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.