Severe traumatic brain injury: clinical research into management used in Bosnia-Herzegovina.

Trauma is number one cause of death in young population in Bosnia & Herzegovina. Department of Neurosurgery, Clinical Center Unversity of Sarajevo (CCUS), as a representative of Bosnia & Herzegovina, participated in the International Research-Treat-Traumatic brain injury project over a span of three years with the main objective to save the lives of patients sustained the traumatic brain injury (TBI) and to improve the quality of life of survivors through research in factors determining the outcome and through changing current clinical practices to provide better care. The scores used to measure the compliance to TBI guidelines at individual patient were developed and tested. The scores were successfully tested on all the patients entered into the database. The patients satisfying the selection criteria were only included into this study. The criteria of severe TBI were used according to the National Traumatic Coma Database established in the US: Glasgow Coma Scale (GCS) score of 8 or less following resuscitation, which may include endotracheal intubation; or GCS score deteriorating to 8 or less within 48 hours of injury. The implementation of Scientific Evidence Based Medicine procedures is followed by a research in efficacy of changed medical practice. This was facilitated by developing a guidelines compliance measurement tool, which evaluates how closely the guidelines are followed in the treatment of individual case. When evaluating the compliance and when discussing the guidelines implementation one of the major problems surfaced is lack of financial support. In the future, we should tend to establish the scientifically basis for dissemination of the Scientific Evidence Based knowledge to all Hospitals in Bosnia& Herzegovina which deal with severe TBI patients. The financial obstacles and misunderstanding could be overcome through creation of public awareness campaign. Reducing mortality of TBI patients, who are youngest and most active part of population, must be priority for our whole community.