Adaptation of traumatic brain injury guidelines in Iran

The National institute for health and care excellence (NICE) and scottish intercollegiate guidelines network (SIGN) are
two well-known sources of clinical guideline development. In the past years, they have developed clinical guidelines for the management
of head injury. In this report, we will highlight our modifications to these guidelines according to the domestic situation
in a developing country.
Evidence Acquisition: The guidelines were appraised using the appraisal of guidelines for research and evaluation (AGREE) instrument.
All key recommendations were reviewed by 14 prominent Iranian neurosurgeons; levels of evidence were evaluated and items
with limited evidence were determined. Available evidence for selected items were reviewed and discussed.
Results: The following items were the most challenging when accounting for the domestic situation in Iran: age as a risk factor
for referral, computed tomography scan, the impact of medical comorbidities, pregnancy, consultation, referral to a neurosurgical
unit, and teleconsulting and observation before discharge.
Conclusions: The evidence in the discussed topics was limited and controversial. This report is important because it exposes the
current knowledge gap in head trauma studies in Iran