New GNS-I results published in Nature Medicine

Global Neurosurg Research Collaborative

A global research collaborative network auditing management practices and evaluating disparities in neurological and neurosurgical care worldwide.

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Featured Publication

The primary results of the GNS-I study are published in Nature Medicine.

Nature Medicine 19 August 2026

Traumatic brain injury outcomes across human development index strata in 29 countries

Nugent JG, Tan H, Stedelin B, Nerison CS, Teton ZE, Zaidan SK, Demetriades AK, Dmytriw AA, Still MEH, Ghaith HS, Zeigler C, Lazio B, Negida A, Raslan AM, and the GNS-I Collaborators.

2,165 Patients Prospectively enrolled, 2019–2022
100 Hospitals Across 29 countries, every HDI tier
32vs63 Median age, years High-HDI vs very-high-HDI
OR3.13 Adjusted mortality odds High-HDI vs very-high-HDI, 95% CI 1.12–8.78

Two different injuries, two different journeys

Leading cause of injury

Low HDI65.8%
Road traffic injuries
Very high HDI66%
Falls

Arrived by private vehicle, not ambulance

Low HDI69.3%
7 in 10 patients
Very high HDI13%
Roughly 1 in 8

What the study found

Adjusted mortality odds were highest in the high-HDI tier, not the poorest one, and there was no dose–response relationship between mortality and HDI. What separated outcomes was not the operating room: it was who gets injured, how, and how they reach care. Prevention aimed at injury mechanisms and prehospital transport may cut the global TBI burden further than hospital-based measures alone.

Read in Nature Medicine View on PubMed
Cite this article

Nugent JG, Tan H, Stedelin B, Nerison CS, Teton ZE, Zaidan SK, et al. Traumatic brain injury outcomes across human development index strata in 29 countries. Nat Med. 2026 Aug 19. doi:10.1038/s41591-026-04600-6

Other GNS publications

In the News

Media coverage of the GNS-I study.

English-language coverage

“You can’t solve a global brain injury crisis in operating rooms alone.”

Ahmed M. Raslan, MD — senior author, quoted in OHSU News
OHSU News

Causes of traumatic brain injury vary widely worldwide, study finds

19 Aug 2026
Medical Xpress

Causes of traumatic brain injury vary widely worldwide, study finds

19 Aug 2026
News-Medical.Net

Global study reveals brain injury prevention lies far outside hospitals

19 Aug 2026
Mirage News

Global Traumatic Brain Injury Causes Vary, Study Reveals

19 Aug 2026

Arabic-language coverage

القاهرة 24 AR

بمشاركة 16 مركزًا مصريًا.. دراسة عالمية في نيتشر ميديسن تكشف الحلقة المفقودة في إنقاذ مصابي الرأس

19 أغسطس 2026
القاهرة 24 AR

الدراسة استمرت من 2018 حتى الآن.. أول تعليق من الفريق البحثي المشارك بأول دراسة دولية مستقبلية تتتبع مرضى إصابات الدماغ

19 أغسطس 2026
نبض AR

الدراسة استمرت من 2018 حتى الآن.. أول تعليق من الفريق البحثي المشارك بأول دراسة دولية مستقبلية تتتبع مرضى إصابات الدماغ

19 أغسطس 2026
16

Egyptian centers — the largest national contribution to GNS-I

Sixteen Egyptian university hospitals and centers contributed to GNS-I, more than any other country: Beni-Suef, Ain Shams (El-Demerdash), Al-Azhar (Al-Hussein), El-Shifa Qena, Alexandria Main University Hospital, Ras El-Tin, Assiut, Misr University for Science and Technology, Mansoura, Menoufia, Qena University Hospitals (South Valley), Sohag, Suez Canal University, Tanta, Royal Wingate Alexandria, and Zagazig.

Covering the study? Contact us at info@globalneurosurg.org.

About GNS

Our Mission

GNS is a global research collaborative network that audits management practices and evaluates disparities in neurological and neurosurgical care worldwide. Our mission is to improve global health outcomes by advancing neurological and neurosurgical practice everywhere it is delivered.

Our Work

We conduct international, multicentre studies to answer clinically relevant research questions in neurological and neurosurgical disease. The global collaborative model enables us to:

  • Compare outcomes across countries
  • Investigate determinants of patient outcome
  • Assess areas of variability in neurological and neurosurgical practice
  • Highlight neurological and neurosurgical needs in developed vs developing countries
01

Global Scope

Studies are conducted in multiple countries; any neurology or neurosurgery center around the world can take part. Over 2,000 collaborators from 84 countries had registered with the network by 2021.

02

Clinically Relevant

Research questions that translate to better patient outcomes.

03

Collaborative Authorship

A collaborative authorship model recognizing contributions from all participating centers.

Similar collaboratives in other surgical areas:

GlobalSurg (General Surgery) Global PaedSurg (Pediatric Surgery)

Our Studies

GNS-I is complete and published. The next round of multicentre studies is in development — registration is open now.

GNS-I Study Completed & Published

Global NeuroSurg 1

Determining the Global Outcomes of Traumatic Brain Injury in Low-, Middle- and High-Income Countries: A Multi-center, International, Prospective Cohort Study

Background

Every year, there are about sixty-nine million new cases of Traumatic Brain Injury (TBI) worldwide. However, there are wide variations in the management of TBI across low-, middle-, and high-income countries which affect TBI outcomes worldwide.

Study Design

A multicenter, international, prospective cohort study. Recruitment ran from 2019 to 2022, with 90 days of follow-up per patient.

Final Cohort

2,165 patients from 100 hospitals across 29 countries, spanning every tier of the Human Development Index and including both operative and non-operative TBI.

Collaborative Model

Data were collected by teams of three — including trainees and medical students — each covering a consecutive two-week period at their own center, with collaborative authorship for every contributing team.

Data Collection

Anonymous data on patient demographics, TBI etiology and severity, clinical and surgical management, and mortality. All data were submitted to the secure REDCap system of the Brain Institute at Oregon Health and Science University, USA.

Read the Results
Next

Upcoming studies

GNS-I proved that a student- and trainee-led collaborative can deliver prospective, cross-continental neurological and neurosurgical data at scale. We are now designing the next round of multicentre studies, and we are building the collaborator list for them.

  • Be notified first when the next protocol opens for recruitment
  • Register your center and your team ahead of launch
  • Collaborative authorship on resulting publications
  • Open to neurosurgeons, neurologists, trauma and emergency physicians, anesthesiologists, trainees and students — anywhere in the world
Register your interest

Already registered for GNS-I? You are on the list — no need to sign up again.

By the Numbers

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GNS-I Collaborators
0
Patients in GNS-I
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Hospitals in GNS-I
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Countries in GNS-I

Our Team

Ahmed Negida, MD, Ph.D.
Virginia Commonwealth University, USA
Ahmed M. Raslan, MBBCh, MD
Oregon Health and Science University, USA
Ahmed Arafa, MD, Ph.D.
Osaka University, Japan
Ahmed Hegazy, MD, Ph.D.
Kasr Alainy School of Medicine, Cairo University, Egypt
Ahmed M. Raslan, MD, Ph.D.
Oregon Health and Science University, USA
Alireza Baratloo, MD
Tehran University of Medical Sciences, Iran
Andrea Mingoli, MD
Policlinico Umberto I – Sapienza University of Rome, Italy
Andreas Demetriades, MD
Edinburgh, UK
Arundhati Biswas, MD
Carle Foundation Hospital, USA
Chengyuan Wu, MD
Thomas Jefferson University, USA
Hieder Al-Shami, MBBCh, MRCS, EFNS
Hytham Hussien Osman, MD
Rabat University Hospital, Sudan
Ignatius Esene, MD, MPH, Ph.D.
Yaounde General Hospital, Cameroon
Jeyaraj Durai Pandian, MD, DM, FRACP, FRCP, FESO
Christian Medical College and Hospital, India
Laligam N. Sekhar, MD
University of Washington, USA
Mahmoud Kamel, MD, FRCS
Aberdeen Royal Infirmary, Scotland, UK
Malik Zaben, MD, MRCS, Ph.D.
Cardiff University, UK
Paul Sudhakar John, MBBS, MS, MCh
Christian Medical College and Hospital, India
Seunggu Jude Han, MD
Oregon Health & Science University, USA
Sudipta Kumer Mukherjee, MD
National Institute of Neurosciences and Hospital, Bangladesh
Walid Abdel Ghany, MD, Ph.D.
Ain Shams University, Egypt
XU Bin, MD
Huashan Hospital & Juha Hernesniemi International Neurosurgery Center, China
Hussien Abdelgawad, MBBCh, MSc
Ignatius Esene, MD, MPH, Ph.D.
Abdelmagid Elmatboly
Ahmed Hassan Sherif
Ahmed Essam, MBBCh
Ahmed Negida, MD
Brittany Stedelin
Hussien Ahmed, MD
Megan Still, MD
Nesrine Ben Hadj Dahman
Zoe Teton, MD
Adam A. Dmytriw, MD
Canada
Ahmad Ghassan Hammouri
Palestine
Alaa Mohammad Hamdan
Syria
Ansam Ghzawi
Jordan
Enoch Ogbonnaya Uche, MBBS, FWACS, FICS, FACS
Nigeria (Southern)
Fachreza Aryo Damara
Indonesia
Ignatius Esene, MD, MPH, Ph.D.
Cameroon
Hytham Hussien Osman, MD
Sudan
Konstantinos Gousias, MD, DSc
Germany
Luis Rafael Moscote-Salazar
Colombia
Mustapha Amnir
Mauritania
Muhammed Elhadi
Libya
Nesrine Ben Hadj Dahman
Tunisia
Obanife Henry Olayere, MD, MSc, FMCS, FWACS
Nigeria
Oumaïma Outani
Morocco
Pierfrancesco Lapolla
Italy
Sadi A. Abukhalaf
Palestine
Sudipta Kumer Mukherjee
Bangladesh
Harun-Arrashid Ibrahim, MBBCh
Mahmoud Saleh
Mahmoud Nassar (IFMSA)
Muhammad Jaafar Adam

Collaborator Roles

There are many ways to contribute to the GNS collaborative

Local Collaborator

  • Applies for ethical approval in their center
  • Works alone or in a team of up to 3 members to collect data during a two-week period
  • Submits data through RedCap system
Register

Lead Local Investigator

  • Coordinates teams in their center
  • Assists in obtaining ethical approvals
  • Invites colleagues and formulates additional teams
  • Participates in pilot evaluation
Register

National Lead

  • Recruits and coordinates at least 5 centers within their country
  • Assists in obtaining ethical approvals
  • Presents GNS studies at national meetings
Contact Us

Regional Lead

  • Invites colleagues across centers in their region
  • Assists in obtaining ethical approvals
  • Presents at national and regional meetings
  • Responds to inquiries from collaborators
Contact Us

Organizer

  • Manages the GNS website
  • Designs presentations and graphics
  • Posts news on social media
  • Assists in registering collaborators
Contact Us

Steering Committee

  • Plans GNS studies
  • Develops and approves study protocols
  • Analyzes data and writes manuscripts
  • Submits studies for publication
Contact Us

Our Outcomes

1

Detecting the gaps in neurological and neurosurgical practice between high-, middle-, and low-income countries and determining the processes associated with the best outcomes.

2

International peer-reviewed publications — beginning with the GNS-I primary results in Nature Medicine — with secondary analyses to follow.

3

Formation of an international network of neurologists/neurosurgeons and trainees to further facilitate future research efforts.

Contact Us

General Inquiries

info@globalneurosurg.org

Ethical Approval Inquiries

approval@globalneurosurg.org

RedCap Access Issues

gnc@ohsu.edu

Principal Investigator

Prof. Ahmed M. Raslan, MD, Ph.D.

raslana@ohsu.edu

Co-PI/Global Lead Coordinator

Dr. Ahmed Negida, MD, PhD

ahmed.said.negida@gmail.com

Contact Address

Oregon Health and Science University
Portland, Oregon, USA

Join the Team