BOOTStrap-SCI: Beyond One option of treatment for spinal trauma and spinal cord injury: Consensus-based stratified protocols for pre-hospital care and emergency room (part I)
Nicolò Marchesini , Andreas K. Demetriades , Oscar Alves , Riya Mandar Dange , Harold Mauricio Choco , Edinson Dussan Lozada , Dumar Javier Figueredo Sanabria , Angélica Gamboa , Luz Llined Mendoza Victoria , Enoc Noscue Montealegre , Jonathan A. Pardo Carranza , Jonathan Velásquez Quintero , Andrès M. Rubiano , the BOOTStraP-SCI Study Group
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Abstract
Introduction
Spinal trauma (STx), with or without spinal cord injury (SCI), represents a significant global health burden, particularly in low- and middle-income countries (LMICs). Existing guidelines often rely on tools and resources that are not always universally available, especially in less resourced settings, contributing to disparities in care and outcomes. A pragmatic, resource-adapted approach may help optimize management in these contexts.
Research question
This study aimed to develop resource-adapted protocols for pre-hospital and emergency room management of STx and SCI, addressing challenges specific to LMICs while supported by clinical evidence and expert based practices.
Material and methods
A multidisciplinary Delphi consensus combined international evidence-based guidelines with expert opinions. Iterative discussions and voting by healthcare providers from LMICs and high-income countries (HICs) ensured the development of context-sensitive protocols. These were tailored to varying levels of training, resource availability, and healthcare infrastructure.
Results
The resulting protocols address key areas of pre-hospital and emergency management, including initial resuscitation, immobilization, clinical interventions, and timely referral. These protocols emphasize adaptability, providing structured plus flexible guidance for optimizing care according to specific contexts from low to high resourced clinical settings.
Discussion and conclusion
The proposed protocols are not intended as gold-standard guidelines but as adaptable frameworks to guide management of STx/SCI in contexts with different availability of resources. By addressing disparities in resource availability and clinical competencies, they can serve as a foundation for local adaptations and improvements in care. Future research should evaluate their implementation and impact on outcomes.
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