ArticleAcute medicine & surgery
Impact of Geographic Distance and Prehospital Delay on Mortality and Functional Outcomes in Severe Traumatic Brain Injury in a Low-Resource Setting.
Article in Acute medicine & surgery. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Background: Traumatic brain injury (TBI) disproportionately affects low- and middle-income countries (LMICs), where prehospital delays and geographic barriers may adversely impact outcomes. Methods: This retrospective study included 1068 consecutive patients with severe TBI (admission Glasgow Coma Scale [GCS] < 9) admitted to Lady Reading Hospital, Peshawar, in 2024. Variables were incident-to-presentation delay, distance, in-hospital timings to surgery, severity markers, mortality, and discharge Glasgow Outcome Scale (GOS). Patients were stratified by urban or rural area according to the place of incident. Statistical analyses included the Mann-Whitney U test, chi-square test, and multivariable logistic regression. Results: The In-hospital mortality was 12.2%, and poor outcomes (GOS ≤ 3) were observed in 95.9%. The median delay before presentation was 6 h (IQR 3-9), with a median distance of 70 km (IQR 6-210). Delays were significantly longer in rural patients (median 9 vs. 3 h in urban areas, Conclusions: Significant disparities in prehospital access were observed; however, no independent association between geographic factors and in-hospital mortality among admitted patients was identified. Functional outcomes remained poor.
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