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Publications

Journal Article Epublish

PubMed: 42769894 DOI: 10.1227/neuprac.0000000000000296

Comparative Effectiveness Research in the Americas on Penetrating Brain Injury: The COMPAS-PBI Study Protocol.

Neurosurg Pract 7(5):e000296

Authors: Ronald Alvarado-Dyer, Ali Mansour, Faddi G Saleh Velez, Camila Bonin-Pinto, Tabitha Garwe, Iván Z González, Walter Videtta, Roxanna Garcia, Camila Narvaez-Caicedo, Phillip Bonney, Julio Mijangos, Sebastián Vásquez-García, Jorge Flecha, Andres Rubiano, Manuel Jibaja, Gabriel Heredia, Sergio Brasil, Wellingson Paiva, Fernando D Goldenberg, Christos Lazaridis

Affiliations

  • Division of Neurocritical Care, Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
  • Division of Neurocritical Care, Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA.
  • Brain Stimulation and Neurorehabilitation Laboratory, Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
  • Brain Stimulation and Neurorehabilitation Laboratory, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
  • Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
  • Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
  • Department of Neurosurgery, Centers for Diagnostics, Advanced Medicine, and Telemedicine (CEDIMAT), Santo Domingo, Dominican Republic.
  • Intensive Care Unit, Hospital Municipal de Merlo, Provincia de Buenos Aires, Argentina.
  • Universidad Nacional del Oeste, Provincia de Buenos Aires, Argentina.
  • Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
  • Division of Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois, USA.
  • Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
  • Department of Intensive Care, Hospital Civil de Guadalajara, Guadalajara, Mexico.
  • Meditech Foundation, Cali, Colombia.
  • Universidad del Rosario, Bogotá, Colombia.
  • Neurosciences Department, Consultant in Neurocritical Care, Clínica del Country, Bogotá, Colombia.
  • Department of Intensive Care, Trauma Hospital, Asunción, Paraguay.
  • Departamento de Neurociencias y Neurocirugía, Universidad El Bosque, Bogotá, Colombia.
  • Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador.
  • Department of Intensive Care, Cayetano Heredia Hospital, Lima, Peru.
  • Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.

Abstract

BACKGROUND AND OBJECTIVES

Penetrating brain injury (PBI) is a highly lethal form of traumatic brain injury, with substantial mortality and marked differences across high-income countries and low- to middle-income countries. The aim of the Comparative Effectiveness Research in the Americas on Penetrating Brain Injury (COMPAS-PBI) study was to evaluate management variability, compare outcomes across resource settings, and assess the feasibility of real-time multinational neurocritical care data collection.

METHODS

COMPAS-PBI is a multinational, multicenter observational comparative effectiveness study. It includes a retrospective cohort (2021-2025) and a prospective cohort (2026-2028) of adults aged 18 years or older with confirmed PBI, defined by radiographic evidence of dural penetration on head computed tomography, presenting within 24 hours of injury. Eleven trauma centers across 8 countries in the Americas will participate, with the University of Oklahoma Health Sciences Campus serving as the coordinating center. The principal management strategies compared are intracranial pressure monitoring vs no monitoring and neurosurgical intervention, primarily early decompressive craniectomy, vs medical management alone. Comparative analyses will use propensity score-based methods to address baseline confounding.

EXPECTED OUTCOMES

The primary outcome is in-hospital mortality. Secondary outcomes include disposition at discharge, Glasgow Outcome Scale-Extended score (at discharge, 6, and 12 months), and timing of intracranial pressure monitoring and decompressive craniectomy. Feasibility outcomes will assess completeness, timeliness, and quality of prospective real-time data capture, particularly in resource-limited settings.

DISCUSSION

COMPAS-PBI will generate the first multinational comparative effectiveness data sets focused on civilian PBI within the Americas. The study is expected to provide pragmatic evidence to inform context-sensitive care strategies, reduce practice differences, and support future collaborative neurotrauma research.

MeSH

Decompressive Craniectomy, Brain Injuries, Mortality, Craniotomy, Intracranial Pressure, Brain, Income, Hospital Mortality, Comparative Effectiveness Research, Research, Wounds And Injuries