
Andres Mariano Rubiano EscobarUniversidad El Bosque · Neurosurgery
Andres Mariano Rubiano Escobar
MD, PhD (c)
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270
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Introduction
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June 2015 - present
July 2010 - July 2015
Publications
Publications (270)
Thirty-four per cent of deaths among Americans aged 1–46 are due to injury, and many of these deaths could be prevented if all hospitals performed as well as the highest-performing hospitals. The Institute of Medicine and the National Academies of Science, Engineering and Medicine have called for learning health systems, with emphasis on clinical p...
Background The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice Open Access
Care for the patient with traumatic brain injury (TBI) in austere or combat environments is challenging because resources are substantially limited as compared with care for these patients in a tertiary medical facility. Significant research has been and will continue to be performed on TBI care in these settings. This includes high-quality, eviden...
Background The epidemiology of traumatic brain injury (TBI) is unclear – it is estimated to affect 27–69 million individuals yearly with the bulk of the TBI burden in low-to-middle income countries (LMICs). Research has highlighted significant between-hospital variability in TBI outcomes following emergency surgery, but the overall incidence and ep...
Moderate traumatic brain injury (TBI) is a diagnosis that describes diverse patients with heterogeneity of primary injuries. Defined by a Glasgow Coma Scale between 9 and 12, this category includes patients who may neurologically worsen and require increasing intensive care resources and/or emergency neurosurgery. Despite the unique characteristics...
The neurological examination has remained key for the detection of worsening in neurocritical care patients, particularly after traumatic brain injury (TBI). New-onset, unreactive anisocoria frequently occurs in such situations, triggering aggressive diagnostic and therapeutic measures to address life-threatening elevations in intracranial pressure...
Background
Skull defects after decompressive craniectomy (DC) cause physiological changes in brain function and patients can have neurologic symptoms after the surgery. The objective of this study is to evaluate whether there are morphometric changes in the cortical surface and radiodensity of brain tissue in patients undergoing cranioplasty and wh...
Objective
This article aims to present a narrative review of current literature about the anatomical characteristics of the scalp as well as current practices in the management of surgical, traumatic and pressure injuries in the scalp, which are common in neurosurgery practice.
Method
We searched PubMed for publications and book chapters in Englis...
Background
The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies.
Methods
A multidisciplinary consensus panel of physicians selected for their es...
Introduction
Neuromonitoring represents a cornerstone in the comprehensive management of patients with traumatic brain injury (TBI), allowing for early detection of complications such as increased intracranial pressure (ICP) [1]. This has led to a search for noninvasive modalities that are reliable and deployable at bedside. Among these, ultrasonog...
Intracranial pressure (ICP) monitoring is necessary for managing patients with traumatic brain injury. Although gold-standard methods include intraventricular or intraparenchymal transducers, these systems cannot be used in patients with coagulopathies or high risk of catheter-related infections nor in resource-constrained settings. Thus, a noninva...
BACKGROUND AND OBJECTIVES
Global disparity exists in the demographics, pathology, management, and outcomes of surgically treated traumatic brain injury (TBI). However, the factors underlying these differences, including intervention effectiveness, remain unclear. Establishing a more accurate global picture of the burden of TBI represents a challeng...
Background: The epidemiology of traumatic brain injury (TBI) is unclear – it is estimated to affect 27–69 million individuals yearly with the bulk of the TBI burden in low-to-middle income countries (LMICs). Research has highlighted significant between-hospital variability in TBI outcomes following emergency surgery, but the overall incidence and e...
BACKGROUND
This paper describes an observational study that aims to evaluate the clinical outcomes of implementing non-invasive monitoring techniques in traumatic brain injury (TBI) patients. The study will collect data on patients treated with hypertonic saline and/or surgery management and assess the relationship between non-invasive neurological...
Background:
Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and guidelines are poorly followed.
Objective:
To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the...
For decades, one of the main targets in the management of severe acute brain injury (ABI) has been intracranial hypertension (IH) control. However, the determination of IH has suffered variations in its thresholds over time without clear evidence for it. Meanwhile, progress in the understanding of intracranial content (brain, blood and cerebrospina...
The year 2015 was pivotal for the growth of global neurosurgery. In January, the United Nations (UN) adopted the Sustainable Development Goals (SDGs), replacing the expiring Millennial Development Goals. The SDGs were more comprehensive, having 17 Goals with 169 associated targets; a significant number of these included the necessity for surgical c...
Best practice guidelines have advanced severe traumatic brain injury (TBI) care, however, little currently informs goals of care decisions and processes despite their importance and frequency. Panelists from the Seattle International severe traumatic Brain Injury Consensus Conference (SIBICC) participated in a survey consisting of 24 questions. Que...
Objective:
To explore the available evidence on hyperosmolar therapies(HT) in mild and moderate traumatic brain injury(TBI) and to evaluate the effects on outcomes.A scoping review was conducted according to the Joanna Briggs Institute methodology. Inclusion criteria: (a)randomized controlled trials(RCTs), prospective and retrospective cohort stud...
Background:
Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons.
Methods:...
Cerebral oxygenation represents the balance between oxygen delivery, consumption and utilization by the brain, and therefore reflects the adequacy of cerebral perfusion. Different factors can influence the amount of oxygen to the brain including arterial blood pressure, hemoglobin levels, systemic oxygenation, and transfer of oxygen from blood to t...
Background
Severe traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarc...
Background:
Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergenc...
•In LMICs, several factor may affect the applicability of guidelines for secondary damage control of spinal cord injury.•In LMICs, the use of steroids for spinal cord injury is heterogeneous and admissions to an intensive care units are limited.•The delays for surgical decompression of spinal cord injury can be significan and vary across income and...
Background: Traumatic Brain Injury (TBI) is a growing global public health concern, representing a significant source of global mortality and morbidity, with low- and middle-income countries (LMICs) bearing the greatest burden. Acknowledging the vast heterogeneity within and between LMICs and High-Income Countries, more generally LMICs do not relia...
Mild traumatic brain injury (mTBI) is the most common type of traumatic brain injury (TBI), and 100–300 individuals per every 100 000 seek medical care for mTBI annually. The Eye Guide is a portable device that evaluates oculomotor function. This device has promising potential to detect trauma-related neurological deficits that are otherwise undete...
Introduction
Nearly every field of medicine has some form of clinical practice guidelines. However, only within the past 5–10 years has the medical community acknowledged the need for well-developed guidelines tailored to the local healthcare needs and the resources available. In most low-income and middle-income countries (LMICs), healthcare worke...
Background
Traumatic brain injury (TBI) is a major global health issue, but low- and middle-income countries (LMICs) face the greatest burden. Significant differences in neurotrauma outcomes are recognised between LMICs and high-income countries. However, outcome data is not consistently nor reliably recorded in either setting, thus the true burden...
•Most spinal trauma worldwide occurs in low-and middle-income countries (LMICs). Several factors may limit the applicability of current guidelines as regards the early management of spinal injury.•The pre-hospital management per se of spinal trauma in LMICs is subject to partial adherence to recommendations, with possible impact on patient outcomes...
Trauma registries play an important role in building capacity for trauma systems. Regularly, trauma registries exist in high-income countries (HICs) but not in Low- and Middle-Income Countries (LMICs). Neurotrauma includes common conditions, like traumatic brain injuries (TBI) and spinal cord injuries (SCI). The development of organized neurotrauma...
•Most spinal trauma occurs in low- and middle-income countries (LMICs), but some elements may limit the application of current guidelines.•In LMICs, a respectable proportion of physicians treating spinal trauma is not aware of any guidelines on this topic.•Most physicians managing spinal trauma in LMICs believe that following the guidelines may pos...
Background
RT-PCR testing is the standard for diagnosis of COVID-19, although it has its suboptimal sensitivity. Chest computed tomography (CT) has been proposed as an additional tool with diagnostic value, and several reports from primary and secondary studies that assessed its diagnostic accuracy are already available. To inform recommendations a...
Background Traumatic brain injury (TBI) has a disproportionately greater impact in low- and middle-income countries (LMICs). One strategy to reduce the burden of disease in LMICs is through the implementation of a trauma registry that standardizes the assessment of each patient's management of care.
Objective This study aims to ascertain the intere...
Objective
Expanded access to training opportunities is necessary to address 5 million essential neurosurgical cases not performed annually, nearly all in low- and middle-income countries (LMICs). To target this critical neurosurgical manpower issue and advance positive collaborations developed the “Global Neurosurgery 2019: A Practical Symposium,”...
Background:
Core Outcome sets (COS) are important and necessary as they help standardize reporting in research studies. Cranioplasty following traumatic brain injury or stroke is becoming increasingly common leading to an ever growing clinical and research interest especially regarding the optimal material, cost-effectiveness, and timing of cranio...
Penetrating traumatic brain injury (pTBI) affects civilian and military populations resulting in significant morbidity, mortality, and healthcare costs. No up-to-date and evidence-based guidelines exist to assist modern medical and surgical management of these complex injuries. A preliminary literature search revealed a need for updated guidelines,...
Background:
Severe traumatic brain injury (sTBI) is a public health issue with great disparity among low- and middle-income countries where the implementation of evidence-based guidelines is challenging because resources are often unavailable. A consensus process including experts in the prehospital, emergency department, neurosurgery, and intensi...
The present study aims to evaluate the accuracy of the prognostic discrimination and prediction of the short-term mortality of the Marshall computed tomography (CT) classification and Rotterdam and Helsinki CT scores in a cohort of TBI patients from a low- to middle-income country. This is a post hoc analysis of a previously conducted prospective c...
INTRODUCTION
The immune response to central nervous system (CNS) injuries has long been considered a significant contributor to secondary injury following neurotrauma however the autoimmune response to the normal immune-privileged CNS has been insufficiently considered. It has been identified as a possible pathomechanism underlying delayed dementia...
Predictors of the central nervous system (CNS) directed autoantibody response after acute CNS injury are poorly understood. We analyzed titers of IgG and IgM autoantibodies to ganglioside GM1 in serial serum specimens collected from human patients following acute spinal cord injury (SCI), traumatic brain injury (TBI) and brain tumor resection. We a...
Background: Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences...
Background Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences i...
Background Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences i...
Abstract
Study design: scoping review
Objectives
To understand the extent and type of evidence on diagnosis, clinical presentation, management, outcomes, and costs of traumatic spinal cord injury (TSCI) in the early stages in Latin America.
Methods
The Joanna Briggs Institute (JBI) methodology for scoping reviews was followed. Extracted data i...
Objective
Neurosurgical guidelines have resulted in improved clinical outcomes and more optimized care for many complex neurosurgical pathologies. As momentum in global neurosurgical efforts has grown, there is little understanding about the application of these guidelines in low- and middle-income countries (LMICs).
Methods
A 29-question survey w...
BACKGROUND
Core Outcome sets (COS) are important and necessary as they help standardize reporting in research studies. Cranioplasty following traumatic brain injury or stroke is becoming increasingly common leading to an ever growing clinical and research interest especially regarding the optimal material, cost-effectiveness, and timing of craniopl...
Low- and middle-income countries experience three times more traumatic brain injury (TBI) cases when compared with their high-income country counterparts. The quality of care patients receive in the prehospital setting and emergency department settings are highly variable and often dependent on computed tomography (CT) availability. The implementat...
Introduction
Prehospital care is an essential component in reducing mortality for patients presenting with emergency medical conditions. Prehospital systems tend to be underdeveloped or non-existent in these areas, with less than 1% of low-income and middle-income country (LMIC) populations served by an organised prehospital system. Mobile health a...
Purpose of review:
The aim of this study was to provide an overview on advances in intracranial pressure (ICP) protocols for care, moving from traditional to more recent concepts.
Recent findings:
Deep understanding of mechanics and dynamics of fluids and solids have been introduced for intracranial physiology. The amplitude or the harmonics of...
The current state of the medical education in neurosurgery at the Latin American and the Caribbean region is not well established in neurosurgical literature. The evolution of the process has been influenced in different periods of time according to international trends in medical education of postgraduate training, since the late 1880s until now....
Transcranial Doppler (TCD/TCCS) is a noninvasive technique that allows the study of cerebral vasculature and its disturbances in real-time, promoting timely therapeutic measures to control cerebral perfusion variables. In the setting of post-traumatic intracranial hypertension, one of the effective interventions for restoration of many intracranial...
RESUMEN
Introducción
Existen brechas en la aplicación de la medicina basada en la evidencia en el campo de trauma y cuidado agudo de emergencias. Una causa importante está relacionada con la falta de comprensión de los conceptos básicos y avanzados de la metodología estadística. La segunda parte de la quinta entrega de esta serie de artículos tien...
Introduction
: Infrascanner is a portable and easy-to-use device that functions based on near infrared spectroscopy and can be utilized in prehospitalary and hospitalary environments and has risen as a promising resort for the detection of potentially lethal intracranial hemorrhages, especially in low-and-middle income countries where access to a t...
Background:
Traumatic brain injury (TBI) is going to be the third-leading cause of death worldwide, according to the WHO. Two European surveys suggested that adherence to brain trauma guidelines is poor. No study has compared compliance between low- (LMICs) and high-income (UHICs) countries. Hence, this study aimed to investigate differences in th...
Spinal cord injury (SCI) is a disease that affects the normal function of the spinal cord. Roadtraffic accidents (RTAs)represent the main cause of SCI worldwide. SCI may generate physical disability and economic dependency, which is especially significant in low-and middle-income countries such as most of the Latin Americancountries.The mainobjecti...
Post-traumatic epilepsy is a form of recurrent symptomatic seizure disorder secondary to brain injury and can appear several years after the head injury. It is the most frequent form of epilepsy in young adults. Although several mechanisms leading to potential brain damage after traumatic brain injury have been proposed, the exact cause is still un...
Traumatic brain injury (TBI) is a global public health concern, since its burden is increasing worldwide especially in low- and middle-income countries (LMICs). Guidelines and protocols regarding management of TBI in LMICs have been recently developed and global neurosurgery as subspecialty has become an ideal source of research for the needs of im...
Importance
Severe traumatic brain injury (sTBI) is a critical health problem in regions of limited resources (RLRs). Younger populations are among the most impacted. The objective of this review is to analyze recent consensus-based algorithms, protocols and guidelines proposed for the care of patients with TBI in RLRs.
Observations
The principal m...
Background: Traumatic brain injury (TBI) is a global public health issue with over 10 million deaths or hospitalizations each year. However, access to specialized care is dependent on institutional resources and public health policy. Phoenix Children's Hospital USA (PCH) and the Neiva University Hospital, Colombia (NUH) compared the management and...
Objective: Shortage of general neurosurgery and specialized neurotrauma care in low resource settings is a critical setback in the national surgical plans of low and middle-income countries (LMIC). Neurotrauma fellowship programs typically exist in high-income countries (HIC), where surgeons who fulfill the requirements for positions regularly stay...
Objectives Latin America is among several regions of the world that lacks robust data on injuries due to neurotrauma. This research project sought to investigate a multi-institution brain injury registry in Colombia, South America, by conducting a qualitative study to identify factors affecting the creation and implementation of a multi-institution...
The scope of this special issue covers recent trends in neurotrauma research in different regions of the world, including studies in cranial and spinal trauma from epidemiological studies to clinical studies. Cross sectional and transversal studies, systematic reviews and meta-analysis are also welcome in order to present the different approaches t...
Background
Traumatic brain injury (TBI) and stroke have devastating consequences and are major global public health issues. For patients that require a cerebral decompression after suffering a TBI or stroke, a decompressive craniectomy (DC) is the most commonly performed operation. However, retrospective non-randomized studies suggest that a decomp...
Background: The Brain Trauma Foundation (BTF) published evidence-based guidelines with a detailed approach to the management of intracranial hypertension (ICH) in traumatic brain injury (TBI) patients. However, management with cerebrospinal fluid (CSF) drainage in TBI patients remains a controversial topic and is a recent addition to the 4th Editio...
Latin America comprises 33 countries and 15 dependencies of other countries, having a population of over 630 million inhabitants(Tables 1 and 2). As one of the most urbanized regions worldwide and with many diverse cities, there is a large variability i n lifeexpectancy and mortality profiles. A recent study on the life expectancy and mortality in...
Introduction
Neurotrauma is an important but preventable cause of death and disability worldwide, with the majority being associated with road traffic collisions (RTCs). The greatest burden is seen in low -and middle- income countries (LMICs) where variations in the environment, infrastructure, population and habits can challenge the success of con...
Introduction
Many healthcare facilities in low-income and middle-income countries are inadequately resourced and may lack optimal organisation and governance, especially concerning surgical health systems. COVID-19 has the potential to decimate these already strained surgical healthcare services unless health systems take stringent measures to prot...