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

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


JournalPLOS One
Publication date – Oct – 2020
Authors – Armand Zimmerman, Samara Fox, Randi Griffin, Taylor Nelp, Erika Bárbara Abreu Fonseca Thomaz, Mark Mvungi, Blandina T Mmbaga, Francis Sakita , Charles J Gerardo, Joao Ricardo Nickenig Vissoci, Catherine A Staton
Keywordsemergency care delays, low-income country, traumatic brain injury
Open access – Yes
SpecialityEmergency surgery, Neurosurgery, Trauma and orthopaedic surgery
World region Eastern Africa
Country: Tanzania
Language – English
Submitted to the One Surgery Index on November 8, 2020 at 7:08 pm
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.

Conclusions
Time to care data is informative, easy to collect, and available in any setting. Our time to care data revealed significant constraints to non-personnel related hospital resources. Severely injured patients with the greatest need for care lacked access to medical imaging, oxygen, and surgery. Insights from our study and future studies will help optimize resource allocation in low-income hospitals thereby reducing delays to care and improving trauma outcomes in LMICs.

OSI Number – 20726
PMID – 33045030

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