TRAIN: a multiphase mixed-methods implementation study to adapt and implement NICE traumatic brain injury guidelines in Lagos State, Nigeria
Traumatic brain injury
The TRAIN study is a stepped-wedge cluster randomised trial (SW-CRT) conducted across public hospitals in Lagos State, following a formative assessment phase. Clusters (health facilities) are randomised to the timing of transition from control (usual care) to intervention using a computer-generated random sequence. The sequence is generated by an independent statistician not involved in implementation, ensuring allocation concealment at the cluster level. Control Phase (Pre-Intervention): Facilities provide standard care for TBI management, reflecting existing practice without structured protocol implementation. Intervention Phase: Facilities implement a contextually adapted TBI care package, which includes: 1. Adapted evidence-based clinical guidelines (based on National Institute for Health and Care Excellence recommendations) 2. Structured provider training (emergency, neurosurgical, and nursing teams) 3. Context-appropriate decision-support tools 4. Standardised neuroprotective care protocols 5. Optimised referral and care coordination processes 6. Continuous quality improvement processes All clusters will transition sequentially from control to intervention until full coverage is achieved.
1. Facilities providing emergency or inpatient traumatic brain injury (TBI) care 2. Healthcare professionals involved in TBI management 3. Patients presenting with TBI (for observational components)
1. Facilities not providing TBI-related services 2. Individuals unwilling or unable to provide consent where required