Epidemiology and delays in neurosurgical care among patients with traumatic brain injury in a regional referral hospital in Sri Lanka: a retrospective cohort study.

Abstract

Objective: The objective of this study was to develop a pilot traumatic brain injury (TBI) registry through a retrospective review of medical records. This was done to investigate the epidemiology and the prevalence of delays to care, both before and after hospital admission, among patients with TBI in the Teaching Hospital Jaffna, a regional referral hospital in Sri Lanka.

Methods: This was a single-center retrospective cohort study, in which purposive sampling was used to select TBI cases treated between January and December 2021. Patients with TBI were initially identified via International Classification of Diseases, Tenth Revision, Clinical Modification codes and then stratified via mechanism of injury and length of stay; data collection was done through a review of physical medical records.

Results: Among the 99 patients with TBI who were identified, the majority (72%) were referred from peripheral facilities without neurosurgical support. Road traffic accidents were the leading cause of injury (68.7%) and death (75.9%). TBIs were classified as mild (50.5%), moderate (21.2%), and severe (28.3%). Eighty percent of patients with TBIs who were referred to neurosurgery received opinions within 2 hours, with no significant association with mortality rate. Compared to patients with mild/moderate TBI, those with severe TBI had shorter median times before receiving neurosurgical opinions and CT scan reports. Delays in CT scan reports resulted in prolonged times to receive neurosurgical management. Most patients were managed without neurosurgical operative intervention, with subsequent neurosurgical interventions linked to a higher mortality rate (HR 6.08, p < 0.001). The inpatient mortality rate was 29.3%, mainly from severe TBIs (69%). Patients needing intracranial pressure monitoring had higher inpatient mortality (p < 0.001). Deteriorating Glasgow Coma Scale scores prior to intervention, typically due to inadequate vital sign stabilization, predicted significantly lower survival rates (52% vs 82%, p = 0.0019).

Conclusions: Patients with TBI in our cohort faced delays in three main areas: lengthy referral pathways, late stabilization of vital signs and intracranial pressure, and initial neurosurgical management. Developing strategies to mitigate these delays in care will be a crucial factor in reducing neurological morbidity and mortality for patients with TBI seeking treatment in resource-limited settings.