Citation

Barthélemy EJ, Spaggiari R, Corley J, Lepard JR, Staffa SJ, Iv V, Servadei F, Park KB. World Neurosurg. 2019; ePub(ePub): ePub.

Affiliation

Global Neurosurgery Initiative/Program in Global Surgery and Social Change/Harvard Medical School/Department of Global Health and Social Medicine, Boston, MA/USA.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.wneu.2019.02.019

PMID

30825623

Abstract

INTRODUCTION: In Cambodia, the most common victims of TBI are males age 20-30 involved in motor vehicle collision. Secondary injury sustained by these patients occurs during the time period between initial insult and hospital admission. Strengthening prehospital systems for TBI in LMICs like Cambodia is therefore a key element of the development agenda for universal health equity. We report a retrospective analysis of the relationship between prehospital delays and TBI outcomes among patients from a large government hospital in Cambodia.

METHODS: Data was collected from 3476 TBI patients admitted to a major government hospital in Phnom Penh, Cambodia from 6/2013-to-6/2018. Patients with missing data, or admitted >8 hours post-injury were excluded. Statistical analyses examined associations between injury-to-admission delay (IAD) and outcomes such as GOS and length of stay (LOS).

RESULTS: 2125 TBI patients (76.85%male) were included. Median age was 27 years (IQR: 22,37). Injury severity at presentation included 1406(66%) mild, 464(22%) moderate and 240(11%) severe cases. No GCS data was available for 15(1%) patients. We found an inverse relationship between IAD and GOS, most evidently for mild and moderate TBI (n=1870; 88%). Regression analysis revealed marked decrease in GOS at IAD>4-hour threshold. Each 30-minute delay in IAD was correlated with >2-hour increase in LOS for mild (p<0.001) and moderate TBI (P<0.001).

CONCLUSIONS: In a retrospective cohort of >2000 TBI patients from Cambodia, we found that increasing IAD was associated with worsening outcome, especially beyond the 4-hour threshold. These data should inform development of prehospital guidelines for TBI care in LMICs.

Copyright © 2019 Elsevier Inc. All rights reserved.

Language: en