Pre-hospital care, pre-hospital delay, and in-hospital delay in patients with traumatic brain injury in getting neurosurgical care in a tertiary care center: A Cross-Sectional study.

Introduction: Timely institution of pre-hospital therapies aimed at damage control and the appropriately timed decision of transfer to higher centers for definitive neurosurgical management are crucial in determining the outcome of patients following traumatic brain injury. This study aimed to evaluate the factors determining pre-hospital care and delay in patients with traumatic brain injury. Methods: This was a descriptive cross-sectional study conducted in a tertiary care center after obtaining ethical approval from the Institutional Review Board (approval number 392 (6-11) E2). All patients with traumatic brain injury who presented to the emergency department from 1 July, 2018 to 15 June, 2019 were enrolled. Data related to patient demographics, the primary cause of the incident, grading of traumatic brain injury on admission, pre-hospital care, and variables that cause pre-hospital delay were collected. Results: In this study of 144 patients with traumatic brain injury, we found that 70 (48.61%) experienced transfer delays exceeding one hour. There were 71 (49.31%) patients aged 15-44 years, and 100 (69.44%) were males , with falls being the primary cause of 119 (82.64%). Most patients had mild traumatic brain injury 80 (55.56%). Out of 144, 20 (13.89%) received prehospital care, and 28 (19.44%) underwent a computed tomography scan of the head before arrival. Conclusions: Our study highlights the challenges in pre-hospital care and delays in reaching for neurosurgical care in patients with traumatic brain injury. Falls, road accidents, and physical assaults were the leading causes.