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    Evaluating Access to Prehospital Care for Traumatic Brain Injury Patients in a Resource Limited Setting: Focus on Prehospital Transport

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    Date
    2015
    Author
    Rotich, Claire C.
    Advisor
    Staton, Catherine Lynch
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    Abstract

    BACKGROUND: This study describes the prehospital transport of traumatic brain injury (TBI) patients and its impact on TBI outcome to inform quality improvement for the existing trauma system. Data was collected over 4 months at a major referral hospital in Moshi,Tanzania.

    METHODS: Patient demographics, mechanism of injury, injury severity (Glasgow Coma Score), and vitals were recorded on presentation to the Casualty Department. Prehospital factors recorded include time, distance and cost. Multivariable regression analyses evaluated the effect of prehospital factors on unfavourable patient TBI outcome, in-hospital factors and demographics were controlled for. Unfavorable outcome was defined as Glasgow Outcome Score<5 on discharge or death.

    RESULTS: Road traffic injuries were the most common mechanism of injury (67.1%). The majority of patients were referred from other facilities in and around the region (62.3%), with 23% from the local public hospital There was no evidence of prehospital care available in this region. Average prehospital duration was more than 1 hour, a third of this was spent in prehospital transit for a majority of the patients. A minority used Ambulances. Predictors of unfavourable outcome (GOS<5) were: prehospital time greater than 60 minutes, multiple physical transfers during the prehospital course and being referred from another hospital.

    CONCLUSION: The lack of prehospital care calls for further research into prehospital interventions for this setting. Further analysis should be conducted with a larger sample size to increase accuracy of the findings.

    Type
    Master's thesis
    Department
    Global Health
    Subject
    Public health
    Sub Saharan Africa studies
    Health sciences
    Access to care
    Health Systems
    Prehospital
    sub-Saharan Africa
    Trauma Systems
    Traumatic Brain Injury
    Permalink
    https://hdl.handle.net/10161/9986
    Citation
    Rotich, Claire C. (2015). Evaluating Access to Prehospital Care for Traumatic Brain Injury Patients in a Resource Limited Setting: Focus on Prehospital Transport. Master's thesis, Duke University. Retrieved from https://hdl.handle.net/10161/9986.
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    This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

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