An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country

Abstract

Background Trauma is a leading cause of death and disability worldwide. In low-and middle-income countries (LMICs), trauma patients have a higher risk of experiencing delays to care due to limited hospital resources and difficulties in reaching a health facility. Reducing delays to care is an effective method for improving trauma outcomes. However, few studies have investigated the variety of care delays experienced by trauma patients in LMICs. The objective of this study was to describe the prevalence of pre-and in-hospital delays to care, and their association with poor outcomes among trauma patients in a low-income setting. Methods We used a prospective traumatic brain injury (TBI) registry from Kilimanjaro Christian Medical Center in Moshi, Tanzania to model nine unique delays to care. Multiple regression was used to identify delays significantly associated with poor in-hospital outcomes. Results Our analysis included 3209 TBI patients. The most common delay from injury occurrence to hospital arrival was 1.1 to 4.0 hours (31.9%). Most patients were evaluated by a physician within 15.0 minutes of arrival (69.2%). Nearly all severely injured patients needed and did not receive a brain computed tomography scan (95.0%). A majority of severely injured patients needed and did not receive oxygen (80.8%). Predictors of a poor outcome included delays to lab tests, fluids, oxygen, and non-TBI surgery.

Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review

“…A report from Tanzania in 2020 found that 95% of all severely injured patients needed but did not receive a brain CT scan. A majority (80.8%) of these patients also needed but did not receive oxygen [ 140 ]. Up to 60% of neurosurgeons managing pediatric neurotrauma reported needing a drill for pediatric neurosurgery [ 92 ].…”

Traumatic Brain Injuries: A Cross-Sectional Study of Traumatic Brain Injuries at a Tertiary Care Trauma Center in the Punjab, Pakistan

“…Another factor in the large difference in mean delay is the poor road network in the more rural aspects of Southern Punjab, which sometimes only allow access for motorbikes or powerful off-road cars. 29 These are both issues that should be investigated and addressed by policy-makers, as even small delays to presentation have been associated with worsened prognoses 30 and significant emphasis in the trauma literature regarding the concept of the "Golden Hour," which indicates that prompt medical and surgical treatment in the initial stages of a traumatic injury can greatly reduce the risk of death. 31 Another interesting aspect of our study was that we found no evidence of adequate prehospital care in patients, as defined by ATLS or American College of Surgeons guidelines.…”

Financial Risk Protection for Neurosurgical Care in Indonesia and the Philippines: A Primer on Health Financing for the Global Neurosurgeon

“…Greater acceptability and buy-in of this mechanism by neurosurgical providers are afforded by strategic purchasing because the costing and payment schedules are negotiated and prearranged in collaboration with the providers themselves. The payments from SHIs to neurosurgical providers can be further complemented by an element of pay-for-performance (32), with a proportion of the fixed payment withheld and paid according to certain indicators such as timeliness of the surgical operation (46), long-term outcomes assessment (47), and even patient satisfaction with the neurosurgeon-patient engagement (48). In this way, the goal of quality care can be achieved for the neurosurgical management of patients with TBI.…”