Evidence map›Paper›PMID 42547675›Full record

ArticleNeurocritical care2026

Impact of Initial Care at a Neurosurgery-Capable Facility on Mortality Among Patients with Moderate-to-Severe Traumatic Brain Injury in South Africa.

Smitha Bhaumik, Lani Finck, Jessica Wild, Mengli Xiao, Adriaan Vlok, Hendrick Lategan, George Oosthuizen, Maria Kohlbrenner, Rachel Patel, Chelsea Dymond and 9 more

Abstract read
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In one paragraph

Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Smitha BhaumikDepartment of Emergency Medicine, University of Colorado School of Medicine, Academic Office 1, Mail Stop C-326, 12631 E 17 Ave, Aurora, CO, 80045, USA.
Lani FinckDepartment of Emergency Medicine, University of Colorado School of Medicine, Academic Office 1, Mail Stop C-326, 12631 E 17 Ave, Aurora, CO, 80045, USA.
Jessica WildDepartment of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
Mengli XiaoDepartment of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
Adriaan VlokDivision of Neurosurgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa.
Hendrick LateganDivision of Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa.
George OosthuizenDivision of Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa.
Maria KohlbrennerDepartment of Emergency Medicine, University of Colorado School of Medicine, Academic Office 1, Mail Stop C-326, 12631 E 17 Ave, Aurora, CO, 80045, USA.
Rachel PatelDepartment of Emergency Medicine, University of Colorado School of Medicine, Academic Office 1, Mail Stop C-326, 12631 E 17 Ave, Aurora, CO, 80045, USA.
Chelsea DymondIntermountain Health Saint Joseph Hospital, Aurora, CO, USA.
Willem StassenDivision of Emergency Medicine, Department of Family, Community and Emergency Care, University of Cape Town, Cape Town, South Africa.
Elaine ErasmusDivision of Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa.
Janette VersterDivision of Forensic Medicine, Department of Pathology, Stellenbosch University, Cape Town, South Africa.
Craig WylieWestern Cape Government Emergency Medical Services, Cape Town, South Africa.
Shaheem de VriesCollaborative for Emergency Care in Africa, Cape Town, South Africa.
Elmin SteynDivision of Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa.
EpiC Study Site Collaborators
Julia DixonDepartment of Emergency Medicine, University of Colorado School of Medicine, Academic Office 1, Mail Stop C-326, 12631 E 17 Ave, Aurora, CO, 80045, USA.
Nee-Kofi Mould-MillmanDepartment of Emergency Medicine, University of Colorado School of Medicine, Academic Office 1, Mail Stop C-326, 12631 E 17 Ave, Aurora, CO, 80045, USA. nee-kofi.mould-millman@cuanschutz.edu.ORCID http://orcid.org/0000-0003-4303-6903

Funding

Defense Health Agency W81XWH19-2-0055Defense Health Agency W81XWH-20-2-0042
6 · The paper itself

Abstract

objectiveModerate-to-severe traumatic brain injury (msTBI) disproportionately affects populations in low- and middle-income countries. This study examines how initial care at a neurosurgery-capable facility (NCF) affects survival.

methodsThis is a secondary analysis of data collected in the EpiC study from the Western Cape of South Africa. The study period was January 2022 to October 2024 and included adult patients with msTBI who survived to hospital arrival. The study compares in-hospital TBI-associated mortality among NCF and non-NCF groups using inverse probability of treatment weighted logistic regression models.

resultsA total of 620 patients with msTBI were included (210 NCF and 410 non-NCF, including 291 who were later transferred to the NCF), with mean age 34 years, 89% male, and 78% blunt injury. NCF group had lower Glasgow Coma Scale (median 4 vs. 9, p < 0.01), worse injury severity (median New Injury Severity Score [NISS] 34 vs. 27, p < 0.01), and greater likelihood of ambulance transport (94% vs. 51%, p < 0.01). NCF group received head computed tomography (CT) earlier (median 6 h vs. 15 h, p < 0.01). Neurosurgical procedures occurred faster for NCF compared with non-NCF patients (median 12 h vs. 23 h, p = 0.13). Almost one-third (29%) of the cohort experienced TBI-associated mortality (37% vs. 25%, p < 0.01). After adjustment for confounders and effect modifiers such as age, sex, EMS arrival, intubation within 24 h of injury, NISS, initial GCS, polytrauma, hypotension, and blood product administration, NCF was associated with lower odds of TBI-associated mortality (adjusted OR 0.51, CI 0.34-0.75, p < 0.01).

conclusionsDirect transport to NCF was associated with improved survival for patients with msTBI in South Africa.

Indexed as

Developing countriesEmergency medical servicesEmergency medicineReferrals and consultationSouth AfricaTraumatic brain injuriesWounds and injuries

Identifiers

PMID42547675

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.