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

Autor: Armand Zimmerman, Catherine A. Staton, Taylor Nelp, Francis M. Sakita, Randi H. Griffin, Erika Bárbara Abreu Fonseca Thomaz, João Ricardo Nickenig Vissoci, Blandina T. Mmbaga, Samara Fox, Mark Mvungi, Charles J. Gerardo
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Emergency Medical Services
Critical Care and Emergency Medicine
Traumatic Brain Injury
Economics
Health Care Providers
Social Sciences
Economic Geography
Tanzania
Diagnostic Radiology
Geographical Locations
0302 clinical medicine
Health facility
Brain Injuries
Traumatic
Emergency medical services
Medicine and Health Sciences
Medicine
030212 general & internal medicine
Prospective Studies
Medical Personnel
Young adult
Prospective cohort study
Tomography
Trauma Medicine
Cause of death
Multidisciplinary
Geography
Radiology and Imaging
Middle Aged
Hospitals
Chemistry
Professions
Treatment Outcome
Physical Sciences
Low and Middle Income Countries
Female
Traumatic Injury
Research Article
Chemical Elements
Adult
medicine.medical_specialty
Referral
Adolescent
Traumatic brain injury
Imaging Techniques
Science
MEDLINE
Surgical and Invasive Medical Procedures
Neuroimaging
Research and Analysis Methods
Time-to-Treatment
03 medical and health sciences
Young Adult
Diagnostic Medicine
Physicians
Humans
Developing Countries
Emergency Treatment
business.industry
Biology and Life Sciences
030208 emergency & critical care medicine
medicine.disease
Computed Axial Tomography
Oxygen
Health Care
Emergency medicine
People and Places
Africa
Earth Sciences
Population Groupings
business
Neurotrauma
Neuroscience
Zdroj: PLoS ONE, Vol 15, Iss 10, p e0240528 (2020)
PLoS ONE
ISSN: 1932-6203
Popis: BackgroundTrauma 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.MethodsWe 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.ResultsOur 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.ConclusionsTime 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.
Databáze: OpenAIRE
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