Temporal Delays in the Management of Traumatic Brain Injury: A Comparative Meta-Analysis of Global Literature.

ABSTRACT

OBJECTIVE: A meta-analysis was conducted to compare 1) time from traumatic brain injury (TBI) to the hospital, and 2) time within the hospital to intervention or surgery, by country-level income, World Health Organization region, and healthcare payment system. METHODS: A comprehensive literature search was conducted and followed by a meta-analysis comparing duration of delays (prehospital and intrahospital) in TBI management. Means and standard deviations were pooled using a random effects model and subgroup analysis was performed using R software. RESULTS: Our analysis comprised 95,554 TBI patients from 45 countries. BY COUNTRY-LEVEL INCOME From 23 low- and middle-income countries, a longer mean time from injury to surgery (862.53 minutes, confidence interval [CI] 107.42-1617.63), prehospital (217.46 minutes, CI -27.34-462.25), and intrahospital (166.36 minutes, 95% CI 96.12-236.60) durations were found compared to 22 high-income countries. BY WHO REGION African Region had the greatest total (1062.3 minutes, CI -1072.23-3196.62), prehospital (256.57 minutes [CI -202.36-715.51]), and intrahospital durations (593.22 minutes, CI -3546.45-4732.89). BY HEALTHCARE PAYMENT SYSTEM Multiple-Payer Health Systems had a greater prehospital duration (132.62 minutes, CI 54.55-210.68) but greater intrahospital delays were found in Single-Payer Health Systems (309.37 minutes, CI -21.95-640.69). CONCLUSION: Our study concludes that TBI patients in low- and middle-income countries within African Region countries face prolonged delays in both prehospital and intrahospital management compared to high-income countries. Additionally, patients within Single-Payer Health System experienced prolonged intrahospital delays. An urgent need to address global disparities in neurotrauma care has been highlighted.