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

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 effe...

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Autores principales: Zimmerman, Armand, Fox, Samara, Griffin, Randi, Nelp, Taylor, Thomaz, Erika Bárbara Abreu Fonseca, Mvungi, Mark, Mmbaga, Blandina T., Sakita, Francis, Gerardo, Charles J., Vissoci, Joao Ricardo Nickenig, Staton, Catherine A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549769/
https://www.ncbi.nlm.nih.gov/pubmed/33045030
http://dx.doi.org/10.1371/journal.pone.0240528
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author Zimmerman, Armand
Fox, Samara
Griffin, Randi
Nelp, Taylor
Thomaz, Erika Bárbara Abreu Fonseca
Mvungi, Mark
Mmbaga, Blandina T.
Sakita, Francis
Gerardo, Charles J.
Vissoci, Joao Ricardo Nickenig
Staton, Catherine A.
author_facet Zimmerman, Armand
Fox, Samara
Griffin, Randi
Nelp, Taylor
Thomaz, Erika Bárbara Abreu Fonseca
Mvungi, Mark
Mmbaga, Blandina T.
Sakita, Francis
Gerardo, Charles J.
Vissoci, Joao Ricardo Nickenig
Staton, Catherine A.
author_sort Zimmerman, Armand
collection PubMed
description 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.
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spelling pubmed-75497692020-10-20 An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country Zimmerman, Armand Fox, Samara Griffin, Randi Nelp, Taylor Thomaz, Erika Bárbara Abreu Fonseca Mvungi, Mark Mmbaga, Blandina T. Sakita, Francis Gerardo, Charles J. Vissoci, Joao Ricardo Nickenig Staton, Catherine A. PLoS One Research Article 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. Public Library of Science 2020-10-12 /pmc/articles/PMC7549769/ /pubmed/33045030 http://dx.doi.org/10.1371/journal.pone.0240528 Text en © 2020 Zimmerman et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Zimmerman, Armand
Fox, Samara
Griffin, Randi
Nelp, Taylor
Thomaz, Erika Bárbara Abreu Fonseca
Mvungi, Mark
Mmbaga, Blandina T.
Sakita, Francis
Gerardo, Charles J.
Vissoci, Joao Ricardo Nickenig
Staton, Catherine A.
An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country
title An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country
title_full An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country
title_fullStr An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country
title_full_unstemmed An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country
title_short An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country
title_sort analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549769/
https://www.ncbi.nlm.nih.gov/pubmed/33045030
http://dx.doi.org/10.1371/journal.pone.0240528
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