An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country.

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.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1371/journal.pone.0240528

Publication Info

Zimmerman, Armand, Samara Fox, Randi Griffin, Taylor Nelp, Erika Bárbara Abreu Fonseca Thomaz, Mark Mvungi, Blandina T Mmbaga, Francis Sakita, et al. (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, 15(10). p. e0240528. 10.1371/journal.pone.0240528 Retrieved from https://hdl.handle.net/10161/22018.

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.

Scholars@Duke

Blandina Mmbaga

Adjunct Associate Professor of Global Health
Gerardo

Charles J. Gerardo

Professor of Emergency Medicine

Dr. Gerardo is Professor and Chair for the Department of Emergency Medicine.  He graduated with honors from Stanford University with a Bachelor’s of Science in Biology, and received his MD degree from University of California, Davis.  He went on to complete his residency training in Emergency Medicine at Loma Linda University Medical Center.  He completed his Masters of Health Sciences from the Duke University Clinical Research and Training Program.  In 2000, he joined Emergency Medicine faculty at Duke University and has served in numerous educational, research and administrative leadership roles. His current research focuses on US and global snake envenomation using a variety of methodologies from transitional science and clinical trials to machine learning and implementation science. He has over 90 peer reviewed publications and book chapters, and is published in JAMA, PLOS Medicine, Annals of Emergency Medicine, Academic Emergency Medicine and Clinical Toxicology. 

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 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 and is now being trialed in an NIAAA funded R01 pragmatic adaptive clinical trial. 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 130 manuscripts.


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