Structural and social barriers to timely care for traumatic brain and spinal cord injury in low- and middle-income countries: a scoping review.

Introduction: Traumatic brain injury and spinal cord injury represent major causes of mortality, disability, and global health burden, with a disproportionate impact in low- and middle-income countries. In these settings, adverse outcomes are not determined solely by the initial severity of injury, but are strongly influenced by delays in care arising from structural and social barriers across the continuum of care. Despite their relevance as a public health and health systems problem, the evidence on these barriers remains fragmented and dispersed, limiting the design of interventions and policies aimed at improving timely trauma care. Methodology: A scoping review will be conducted in accordance with the Joanna Briggs Institute recommendations and reported following the PRISMA-ScR guidelines. The research question was structured using the Population–Concept–Context framework, considering adult populations with traumatic brain injury and/or spinal cord injury, structural and social barriers affecting timely care, and low- and middle-income countries. A systematic search will be performed in PubMed, Scopus, Web of Science, and the WHO Global Index Medicus for studies published between January 2010 and February 2026, in English and with full-text availability. Study selection will be conducted in two phases by independent reviewers using Rayyan. Data extraction will be performed using a standardised matrix, and synthesis will be developed descriptively and narratively, without formal risk of bias assessment or meta-analysis. Expected results: The findings will allow mapping and classification of the structural and social barriers that condition timely care for traumatic brain and spinal cord injury in low- and middle-income countries, distinguishing their impact at prehospital, hospital, and systemic levels. Recurrent patterns of barriers related to infrastructure, service organisation, human resources, transport, financing, and social determinants are expected to be identified, as well as their association with delays in care, increased mortality, and disability. In addition, the review will identify relevant knowledge gaps and priority areas for future research, health system strengthening, and public policy formulation aimed at improving trauma outcomes in these settings.