From trauma capacity to neurotrauma capacity: A scoping review of existing assessment frameworks.

Introduction: Neurotrauma, comprising traumatic brain injury (TBI) and traumatic spinal cord injury (tSCI), remains a major global health issue, with low- and middle-income countries (LMICs) bearing a disproportionate burden. Effective neurotrauma care requires timely and coordinated access to prehospital care, imaging, surgery, neurocritical care, and rehabilitation, yet current assessment frameworks often fail to capture these interdependent requirements. Research question: What instruments are currently available to evaluate trauma and neurosurgical capacity across diverse global settings, and to what extent do these tools capture indicators relevant to neurotrauma care? Material and methods: We conducted a scoping review following JBI methodology and PRISMA-ScR guidelines. We searched PubMed/MEDLINE, Embase, Web of Science, and Global Health from inception to March 2026, supplemented by grey literature. We included studies describing instruments assessing system or facility-level capacity for trauma or neurosurgical care. Data extraction and domain mapping were performed independently by two reviewers. Results: Twenty-six documents were included, describing 19 distinct instruments. Instruments were categorized as surgical capacity (n = 4), trauma capacity (n = 4), neurosurgical/neurocritical care capacity (n = 4), and quality indicator sets (n = 7). Emergency and imaging readiness was the most frequently covered domain (89%), followed by quality and audit systems (68%), operative capacity (53%), and neurocritical care (47%). Prehospital referral systems and workforce/training were the least covered domains (37% each). Only two instruments covered all six predefined neurotrauma domains. Discussion and conclusion: Existing tools assess important components of trauma and neurosurgical capacity but remain heterogeneous and fragmented. No identified instrument provides a comprehensive, multidisciplinary assessment of neurotrauma capacity across the full continuum of care. These findings support the development of an integrated framework combining indicators across the neurotrauma care pathway.