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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

Author

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  • 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

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.

Suggested Citation

  • 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 , 2020. "An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-16, October.
    • Handle: RePEc:plo:pone00:0240528
    DOI: 10.1371/journal.pone.0240528
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    References listed on IDEAS

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    1. Hubert Amu & Kwamena Sekyi Dickson & Akwasi Kumi-Kyereme & Eugene Kofuor Maafo Darteh, 2018. "Understanding variations in health insurance coverage in Ghana, Kenya, Nigeria, and Tanzania: Evidence from demographic and health surveys," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-14, August.
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