Temporal Delays Along the Neurosurgical Care Continuum for Traumatic Brain Injury Patients at a Tertiary Care Hospital in Kampala, Uganda.
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2019-01
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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.
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Vaca, Silvia D, Benjamin J Kuo, Joao Ricardo Nickenig Vissoci, Catherine A Staton, Linda W Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, et al. (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.
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Scholars@Duke
Catherine Ann Staton
Catherine Staton MD MSc
Dr. Staton is a 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 Christian Medical Center, Tanzania Dr. Staton demonstrated 30% of injury patients had at risk alcohol use, providing preliminary data for a K01/Career Development Award. Her K01 award adapted a brief alcohol intervention to the KCMC ED and Swahili. This intervention has been proven to reduce 26 binge drinking events per year compared to usual care, and the team is now planning for regional implementation. Dr. Staton and her mentor and collaborator Dr. Mmbaga are co-PD of the “The TReCK Program: Trauma Research Capacity Building in Kilimanjaro” to train 12 masters and doctoral learners to conduct innovative implementation and data science projects to improve care for injury patients. Currently, Dr. Staton and GEMINI partners with over a dozen faculty from over 6 low- and middle-income countries to conduct research, has mentored over 150 learners from undergraduate to post-doctoral levels from high, middle and low- income settings and has over 160 manuscripts.
Henry Elliot Rice
Gerald Arthur Grant
Michael Martin Haglund
My clinical areas of expertise include spinal surgery, especially cervical spine surgery where I have performed almost 8,300 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, CRNAs, and anesthesiologists. I also believe in the spiritual side in taking care of my patients. As a design surgeon we are developing better ways to treat cervical spine disease through innovative approaches to the cervical spine.
Through my Masters in Academic Medicine degree, I developed the Surgical Autonomy Program which is now used in 7 Neurosurgery Programs across the country and is an innovative way to teach, assess, and provide feedback to residents in the intraoperative environment. Over the last twelve years we have developed the first ever Division of Global Neurosurgery and Neurology (launched in 2014), where I serve as the Division Chief and the Division boasts over 100 members including faculty, graduate and medical students, undergraduate students and an outstanding staff of researchers, most located in the Duke Global Health Institute. The Division has published over 120 manuscripts between 2014 and 2023. We have primarily worked in building capacity, teaching, and collaborative research projects in Uganda. In 2019 I was invited to join the faculty at the Duke-Singapore Global Health Institute and we are working with the Singapore Neuroscience Department to develop outreach and increase capacity in Jaffna, Sri Lanka.
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