{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:29:55Z","timestamp":1786364995258,"version":"build-2736575974"},"reference-count":34,"publisher":"SAGE Publications","issue":"17-18","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100009898","name":"Defense Health Agency","doi-asserted-by":"crossref","award":["W81XWH-20-2-0042"],"award-info":[{"award-number":["W81XWH-20-2-0042"]}],"id":[{"id":"10.13039\/100009898","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100009898","name":"Defense Health Agency","doi-asserted-by":"crossref","award":["W81XWH19-2-0055"],"award-info":[{"award-number":["W81XWH19-2-0055"]}],"id":[{"id":"10.13039\/100009898","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:p>Traumatic brain injury (TBI) accounts for approximately 2.5 million deaths yearly, with patients living in low- and middle-income countries disproportionally affected. Nonsurgical critical resuscitation interventions (nsCRIs) studied individually have been shown to improve outcomes in moderate-to-severe TBI (msTBI) patients. This cohort study primarily assesses the relationship between timeliness of delivery of grouped nsCRIs and all-cause 7-day mortality among blunt and\/or penetrating isolated msTBI patients, with secondary objectives of 3- and 30-day mortality and discharge Glasgow Coma Scale (GCS). Adult trauma patients with isolated msTBI from January 2022 to December 2024 were enrolled from facilities in a trauma referral pathway in the Western Cape of South Africa. Cohort patients were categorized into treatment subgroups of those receiving nsCRI \u22641 h or nsCRI within 1\u20133 h; the reference group was receiving nsCRI &gt;3 h from injury or missed nsCRIs. Inverse probability weighted Cox proportional hazard regression was used to model mortality outcome. Subgroup and sensitivity analyses were performed. Of the 507 patients within the cohort, 68.6% of patients had blunt injuries, and one-half had severe TBI. 21.7% of all msTBI patients died within 3 days, 27.6% deceased by 7 days, and 31.2% deceased within 30 days. There was a 26% (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.56, 0.98) 7-day mortality reduction among patients who received nsCRIs \u22641 h compared with the reference group. The subgroup of blunt and blunt with penetrating injured patients showed a 21% 7-day mortality benefit (HR = 0.79, 95% CI: 0.71, 0.88) and better discharge GCS categories among patients receiving timely nsCRIs (odds ratio = 1.79; 95% CI: 1.01, 3.19). Among severe TBI patients, there was a 29% 7-day mortality reduction in the nsCRI \u22641 h compared with &gt;3 h or missed nsCRI (HR = 0.71, 95% CI: 0.5, 1.00). While those statistically significant subgroup findings should be interpreted with caution and several subgroup analyses did not show statistical significance, there was an overall trend towards survival benefit associated with nsCRIs at either \u22641 h and\/or 1\u20133 h. Overall, in this cohort study of msTBI patients receiving care in a resource-limited trauma system, we found that nsCRIs delivered within 3 h were associated with improved 7-day mortality and neurological outcomes at discharge.<\/jats:p>","DOI":"10.1177\/08977151261427265","type":"journal-article","created":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T02:53:27Z","timestamp":1775876007000},"page":"1483-1493","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Nonsurgical Critical Resuscitative Interventions on Mortality and Neurological Outcomes in Isolated Moderate-to-Severe Traumatic Brain Injury in a Resource-Limited Health System"],"prefix":"10.1177","volume":"43","author":[{"given":"Chelsea","family":"Dymond","sequence":"first","affiliation":[{"name":"Providence St. Joseph, Emergency Medicine, Eureka, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengli","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Dixon","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lani","family":"Finck","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrick","family":"Lategan","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Division of Surgery, Stellenbosch University, Cape Town, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriaan","family":"Vlok","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Division of Neurosurgery, Stellenbosch University, Cape Town, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Oosthuizen","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Division of Surgery, Stellenbosch University, Cape Town, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaheem","family":"de Vries","sequence":"additional","affiliation":[{"name":"Collaborative for Emergency Care in Africa, Cape Town, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Wylie","sequence":"additional","affiliation":[{"name":"Emergency Medical Services, Western Cape Government Health and Wellness, Cape Town, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janette","family":"Verster","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Forensic Medicine, Stellenbosch University, Cape Town, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Gamboa","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven G.","family":"Schauer","sequence":"additional","affiliation":[{"name":"US Army Institute of Surgical Research (USAISR), San Antonio, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Dengler","sequence":"additional","affiliation":[{"name":"Military Traumatic Brain Injury Initiative (MTBI2), Uniformed Services University, Bethesda, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nee-Kofi","family":"Mould-Millman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"EpiC Study Site Collaborators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"e_1_3_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2025.01.001"},{"key":"e_1_3_5_3_1","unstructured":"2.WHO. 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