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Temporal Delays Along the Neurosurgical Care Continuum for Traumatic Brain Injury Patients at a Tertiary Care Hospital in Kampala, Uganda
- Source :
- Neurosurgery
- Publication Year :
- 2018
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2018.
-
Abstract
- BACKGROUND Significant care continuum delays between acute traumatic brain injury (TBI) and definitive surgery are associated with poor outcomes. Use of the “3 delays” model to evaluate TBI outcomes in low- and middle-income countries has not been performed. OBJECTIVE To describe the care continuum, using the 3 delays framework, and its association with TBI patient outcomes in Kampala, Uganda. METHODS Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June to 30 November 2016. Four time intervals were constructed along 5 time points: injury, hospital arrival, neurosurgical evaluation, computed tomography (CT) results, and definitive surgery. Time interval differences among mild, moderate, and severe TBI and their association with mortality were analyzed. RESULTS Significant care continuum differences were observed for interval 3 (neurosurgical evaluation to CT result) and 4 (CT result to surgery) between severe TBI patients (7 h for interval 3 and 24 h for interval 4) and mild TBI patients (19 h for interval 3 and 96 h for interval 4). These postarrival delays were associated with mortality for mild (P = .05) and moderate TBI (P = .03) patients. Significant hospital arrival delays for moderate TBI patients were associated with mortality (P = .04). CONCLUSION Delays for mild and moderate TBI patients were associated with mortality, suggesting that quality improvement interventions could target current triage practices. Future research should aim to understand the contributors to delays along the care continuum, opportunities for more effective resource allocation, and the need to improve prehospital logistical referral systems.
- Subjects :
- medicine.medical_specialty
Referral
Traumatic brain injury
Psychological intervention
Global neurosurgery
Prospective data
Care continuum
Time-to-Treatment
Tertiary Care Centers
03 medical and health sciences
0302 clinical medicine
Brain Injuries, Traumatic
Definitive surgery
Humans
Medicine
Uganda
Prospective Studies
business.industry
Continuity of Patient Care
Tertiary care hospital
medicine.disease
Triage
Care Continuum
Mulago
Research—Human—Clinical Studies
Prospective registry
030220 oncology & carcinogenesis
Emergency medicine
Surgery
Neurology (clinical)
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15244040 and 0148396X
- Volume :
- 84
- Database :
- OpenAIRE
- Journal :
- Neurosurgery
- Accession number :
- edsair.doi.dedup.....0e826377eb51bd9471cc59bba1a72748