@article{ref1,
title="Third delay in traumatic brain injury: time to management as a predictor of mortality",
journal="Journal of neurosurgery",
year="2019",
author="Gupta, Saksham and Khajanchi, Monty and Kumar, Vineet and Raykar, Nakul P. and Alkire, Blake C. and Roy, Nobhojit and Park, Kee B.",
volume="ePub",
number="ePub",
pages="1-7",
abstract="OBJECTIVETraumatic brain injury (TBI) is a global epidemic with an increasing incidence in low- and middle-income countries (LMICs). The time from arrival at the hospital to receiving appropriate treatment (&quot;third delay&quot;) can vary widely in LMICs, although its association with mortality in TBI remains unknown.<br><br>METHODSA retrospective cohort analysis with multivariable logistic regression was conducted using the Toward Improved Trauma Care Outcomes in India database, which contains data from 4 urban trauma centers in India from 2013-2015.<br><br>RESULTSThere were 6278 TBIs included in the cohort. The patients' median age was 39 years (interquartile range 27-52 years) and 80% of patients were male. The most frequent mechanisms of injury were road traffic accidents (52%) and falls (34%). A majority of cases were transfers from other facilities (79%). In-hospital 30-day mortality was 27%; of patients who died, 21% died within 24 hours of arrival. The median third delay was 10 minutes (interquartile range 0-60 minutes); 34% of cases had moderate third delay (10-60 minutes) and 22% had extended third delay (≥ 61 minutes). Overall 30-day mortality was associated with moderate third delay (OR 1.3, p = 0.001) and extended third delay (OR 1.3, p = 0.001) after adjustment by pertinent covariates. This effect was pronounced for 24-hour mortality: moderate and extended third delays were independently associated with ORs of 3.4 and 3.8, respectively, for 24-hour mortality (both p < 0.001).<br><br>CONCLUSIONSThird delay is associated with early mortality in patients with TBI, and represents a target for process improvement in urban trauma centers.<p /> <p>Language: en</p>",
language="en",
issn="0022-3085",
doi="10.3171/2018.8.JNS182182",
url="http://dx.doi.org/10.3171/2018.8.JNS182182"
}