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Temporal Delays Along the Neurosurgical Care Continuum for Traumatic Brain Injury Patients at a Tertiary Care Hospital in Kampala, Uganda.

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Date
2019-01
Authors
Vaca, Silvia D
Kuo, Benjamin J
Nickenig Vissoci, Joao Ricardo
Staton, Catherine A
Xu, Linda W
Muhumuza, Michael
Ssenyonjo, Hussein
Mukasa, John
Kiryabwire, Joel
Rice, Henry E
Grant, Gerald A
Haglund, Michael M
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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 article
Subject
Humans
Prospective Studies
Continuity of Patient Care
Uganda
Tertiary Care Centers
Time-to-Treatment
Brain Injuries, Traumatic
Permalink
https://hdl.handle.net/10161/25897
Published Version (Please cite this version)
10.1093/neuros/nyy004
Publication 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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Scholars@Duke

Grant

Gerald Arthur Grant

Allan H. Friedman Distinguished Professor of Neurosurgery
Haglund

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
Rice

Henry Elliot Rice

Professor of Surgery
Staton

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
Alphabetical list of authors with Scholars@Duke profiles.
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