Temporal Delays Along the Neurosurgical Care Continuum for Traumatic Brain Injury Patients at a Tertiary Care Hospital in Kampala, Uganda.
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.
Type
Journal articleSubject
HumansProspective Studies
Continuity of Patient Care
Uganda
Tertiary Care Centers
Time-to-Treatment
Brain Injuries, Traumatic
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https://hdl.handle.net/10161/25897Published Version (Please cite this version)
10.1093/neuros/nyy004Publication Info
Vaca, Silvia D; Kuo, Benjamin J; Nickenig Vissoci, Joao Ricardo; Staton, Catherine
A; Xu, Linda W; Muhumuza, Michael; ... Haglund, Michael M (2019). Temporal Delays Along the Neurosurgical Care Continuum for Traumatic Brain Injury
Patients at a Tertiary Care Hospital in Kampala, Uganda. Neurosurgery, 84(1). pp. 95-103. 10.1093/neuros/nyy004. Retrieved from https://hdl.handle.net/10161/25897.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Gerald Arthur Grant
Allan H. Friedman Distinguished Professor of Neurosurgery
Michael Martin Haglund
Duke Surgery Distinguished Professor of Neurosurgery in the School of Medicine
My clinical areas of expertise include spinal surgery, especially cervical spine surgery
where I have performed almost 8,00 cervical spine procedures and recently was ranked
the top cervical spine surgeon in the country by MPIRICA (an analytical company that
reviews surgical outcomes). I believe the whole patient is important and we emphasize
time with the patient and careful discussions regarding possible surgery. Our excellent
results are due to a great team of physicians, nurses, CRN
Henry Elliot Rice
Professor of Surgery
Catherine Ann Staton
Associate Professor of Emergency Medicine
Catherine Staton MD MSc
Dr. Staton is an Associate Professor in Emergency Medicine (EM), Neurosurgery & Global
Health with tenure at Duke University. She is the Director of the GEMINI (Global EM
Innovation & Implementation) Research Center and the EM Vice Chair of Research Strategy
& Faculty Development. Her research integrates innovative implementation methods into
health systems globally to improve access to acute care. In 2012, with an injury registry
at Kilimanjaro Chr
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