Traumatic brain injury (TBI) remains a leading cause of mortality and disability in Colombia and other low- and middle-income countries (LMICs), where disparities in resource availability limit implementation of standardized care. The first edition of BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol), published in 2020, provided guidance for TBI management across variable healthcare settings. Advances in neurotrauma care prompted development of an updated protocol. How can TBI management be optimized across prehospital care, emergency care, neurosurgical surgery, and intensive care phases in settings with varying resource availability? A multidisciplinary panel of 17 national experts in prehospital care, emergency medicine, neurosurgery, and intensive care conducted a structured consensus process using Delphi principles and Nominal Group Technique. Eleven predefined clinical questions were addressed. Recommendations were developed through subgroup work, literature review, and iterative voting, requiring ≥70% agreement at subgroup level and ≥90% plenary consensus. Final algorithms were stratified according to resource availability and healthcare complexity. The second BOOTStraP edition produced 9 integrated management algorithms covering prehospital transport, emergency care, neurosurgical decision-making, and critical care. Interventions are stratified and color-coded by resource requirements, enabling feasible actions in low-, intermediate-, and high-resource settings. Algorithms integrate neuroprotection goals, triage criteria, surgical indications, and monitoring strategies. BOOTStraP provides a pragmatic, phase-based, resource-sensitive framework bridging evidence-based recommendations with real-world constraints. This approach supports context-adapted decision-making and may reduce secondary brain injury while improving standardization of TBI care in resource-limited environments.

Background/Objectives: Traumatic brain injury (TBI) is a global public health concern, affecting over 60 million people annually. It is associated with high rates of mortality and disability, particularly among young and economically active individuals, and remains the leading cause of death in people under 40 years of age. Although computed tomography (CT) is the standard method for excluding intracranial bleeding (ICB), it is frequently unavailable in resource-limited settings where the burden of TBI is greatest. The InfraScanner 2000 is a near-infrared spectroscopy (NIRS) device designed to detect ICB and may serve as a triage tool in environments without access to CT imaging. This study aimed to evaluate the diagnostic performance of the InfraScanner 2000 for detecting ICB in the emergency department (ED) of a trauma center in a cohort of Colombian patients with TBI. Methods: This prospective study was conducted in Cali, Colombia, between December 2019 and February 2021. Adult patients presenting to the ED with blunt TBI were enrolled. InfraScanner assessments were performed according to a standardized protocol, and all participants underwent head CT within 6 h of injury. Results: A total of 140 patients were included. Of these, 66% were male and 34% were female. Most patients (63.57%) were between 18 and 39 years old, with a median age of 39 years (IQR: 18–86). The InfraScanner demonstrated a sensitivity of 60.0% (95% CI: 32.5–84.8), specificity of 78.4% (95% CI: 71.2–85.6), positive predictive value (PPV) of 25.0%, and negative predictive value (NPV) of 94.2% for detecting ICB. Conclusions: The InfraScanner 2000 showed good specificity and high NPV in identifying ICB among Colombian patients with TBI. These findings suggest it could serve as a useful triage tool to support decision-making in emergency settings with limited access to CT imaging.