• World Neurosurg · Dec 2023

    Review

    Factors Delaying the Continuum of Care for the Management of Traumatic Brain Injury in Low- and-Middle Income Countries: A Systematic Review.

    • Muhammad Shakir, Ahmed Altaf, Hammad Atif Irshad, Nowal Hussain, Sonia Pirzada, Mahnoor Tariq, Yesel Trillo-Ordonez, and Syed Ather Enam.
    • Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. Electronic address: muhammad.shakir@alumni.aku.edu.
    • World Neurosurg. 2023 Dec 1; 180: 169193.e3169-193.e3.

    BackgroundConsidering the disproportionate burden of delayed traumatic brain injury (TBI) management in low- and middle-income countries (LMICs), there is pressing demand for investigations. Therefore, our study aims to evaluate factors delaying the continuum of care for the management of TBIs in LMICs.MethodsA systematic review was conducted with PubMed, Scopus, Google Scholar and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Observational studies with TBI patients in LMIC were included. The factors affecting management of TBI were extracted and analyzed descriptively.ResultsA total of 55 articles were included consisting of 60,603 TBI cases from 18 LMICs. Road traffic accidents (58.7%) were the most common cause of injury. Among included studies, factors contributing to prehospital delays included a poor referral system and lack of an organized system of referral (14%), long travel distances (11%), inadequacy of emergency medical services (16.6%), and self-treatment practices (2.38%). For in-hospital delays, factors such as lack of trained physicians (10%), improper triage systems (20%), and absence of imaging protocols (10%), lack of in-house computed tomography scanners (35%), malfunctioning computed tomography scanners (10%), and a lack of invasive monitoring of intracranial pressure (5%), limited theater space (28%), lack of in-house neurosurgical facilities (28%), absence of in-house neurosurgeons (28%), and financial constraints (14%) were identified.ConclusionsSeveral factors, both before and during hospitalization contribute to delays in the management of TBIs in LMICs. Strategically addressing these factors can help overcome delays and improve TBI management in LMICs.Copyright © 2023 Elsevier Inc. All rights reserved.

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