Traumatic brain injuries in a district level emergency department in Cape Town: describing patients' journey from arrival to CT scan and neurosurgery.

backgroundAnnually, 69 million people worldwide suffer a traumatic brain injury (TBI) with a disproportionately high prevalence of 500 to 800 per 100 000 population in low- and middle-income countries. Delays to accessing CT scan and neurosurgical services are associated with worse outcomes. This study describes the pathway from injury to CT scan and neurosurgery of patients with TBIs that presented to a district level emergency department (ED) in Cape Town.

methodsThis was a retrospective cross-sectional analysis of patients presenting to a district level hospital in Cape Town and data were collected from existing databases and registries. All adult patients (≥ 13 years) who presented to the ED from 01 July 2021 till 30 June 2022 (12 months) with a suspected TBI and had a CT brain were eligible for inclusion. The description of the care pathway involved transfers to the nearby tertiary facility to access after-hour CT scan and neurosurgical services via interfacility transfers, as well as a description of emergency medical services (EMS) mission times for primary calls.

resultsA total of 564 participants with TBIs were included in the final sample: n = 462 (82%) mild (GCS 13–15), n = 52 (9%) moderate (GCS 9–12) and n = 50 (9%) severe (GCS 3–8). Interpersonal violence accounted for more than half of injuries (n = 311, 55%), followed by traffic-related crashes (n = 115, 20%). For moderate and severe TBI, the median door-to-CT-scan time were 12 h and 9 h respectively, and door-to-neurosurgery time were 28 h and 20 h respectively. More than half (n = 305, 54%) of the CT scans were performed at the district facility, despite 73% (n = 410) of participants presenting outside of office hours. EMS transferred more than half (n = 302, 54%) of participants between the district and tertiary facilities.

conclusionThis study provides an understanding of patient journeys and pathway to access CT scan and neurosurgical services. Door-to-CT-scan time is much longer than what evidence suggest and relies heavily on interfacility transfers to access services. In particular, the pathway of the mild TBI cohort may require revision from a contextual best practice and limited resources point of view. CLINICAL TRIAL: Not applicable.