RESUMO
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, WHO 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 LMICs, a longer mean time from injury to surgery (862.53 minutes, CI: 107.42-1617.63), pre-hospital (217.46 minutes, CI: -27.34 - 462.25), and intra-hospital (166.36 minutes, 95% CI: 96.12 - 236.60) durations were found compared to 22 HICs. BY WHO REGION: African Region (AFR) had the greatest total (1062.3 minutes, CI: -1072.23-3196.62), pre-hospital (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 (MPHS) had a greater pre-hospital duration (132.62 minutes, CI: 54.55 - 210.68) but greater intrahospital delays were found in Single-Payer Health Systems (SPHS) (309.37 minutes, CI: -21.95 - 640.69). CONCLUSION: Our study concludes that TBI patients in LMIC within AFR countries face prolonged delays in both prehospital and intra hospital management compared to HIC. Additionally, patients within SPHS experienced prolonged intra-hospital delays. An urgent need to address global disparities in neurotrauma care has been highlighted.
