• Alireza Mansouri, Jerry C Ku, Kathleen J Khu, Muhammad R Mahmud, Cara Sedney, Ahmed Ammar, Bruno L Godoy, Aram Abbasian, and Mark Bernstein.
• Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada; Neuro-Oncology Branch (NOB), National Institutes of Health (NIH), Bethesda, Maryland, USA. Electronic address: alireza.mansouri@utoronto.ca.
• World Neurosurg. 2018 Sep 1; 117: e679-e691.

BackgroundIn low- and middle-income countries (LMICs), 11.8% of the need for neurosurgical care is met. Delays in seeking and receiving care may further exacerbate this situation. Objective analysis of delay and its consequences is contingent on reference to established resource-appropriate acceptable timeframes. This study sought to 1) establish an estimate of the landscape of care provided in LMICs and 2) explore reasonable timeframes for various stages of patient-health care interaction.MethodsConsensus input from neurosurgeons in select LMICs was collected; 1 high-income country was included for comparison. In phase 1, participants were asked to select neurosurgical procedures performed at their centers. In phase 2, based on procedures shared among all LMICs, representative case scenarios were generated and participants provided input on acceptable timeframes for each stage of patient-health care interaction: 1) presentation to health services, 2) diagnosis by primary care physician, 3) referral to neurosurgical specialist care, and 4) definitive neurosurgical management.ResultsTwenty neurosurgeons across 18 centers were identified; 12 participated in phase 1 and 7 in phase 2. The range of procedures offered was broad, similar in scope to high-income countries, and included pediatric and adult neurosurgery, trauma, degenerative spine, and hemorrhagic stroke. Acceptable timeframes had wide ranges in certain cases; however, the overall trend showed agreement between the participants.ConclusionsThis exploratory analysis identified reasonable timeframes for the provision of neurosurgical care in LMICs. If validated, these data can be used to more objectively assess the prevalence of delay in neurosurgical care in individual LMICs, along with its consequences.Copyright © 2018 Elsevier Inc. All rights reserved.

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