• Muhammad Shakir, Hammad Atif Irshad, Noor Ul Huda Ibrahim, Zayan Alidina, Muneeb Ahmed, Sonia Pirzada, Nowal Hussain, Kee B Park, 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. 2024 Aug 1; 188: 185198.e10185-198.e10.

ObjectiveA 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.MethodsA 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.ResultsOur analysis comprised 95,554 TBI patients from 45 countries.By Country Level IncomeFrom 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 RegionAfrican 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 SystemMultiple-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).ConclusionOur 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.Copyright © 2024 Elsevier Inc. All rights reserved.

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