TY  - JOUR
PY  - 2019//
TI  - Third delay in traumatic brain injury: time to management as a predictor of mortality
JO  - Journal of neurosurgery
A1  - Gupta, Saksham
A1  - Khajanchi, Monty
A1  - Kumar, Vineet
A1  - Raykar, Nakul P.
A1  - Alkire, Blake C.
A1  - Roy, Nobhojit
A1  - Park, Kee B.
SP  - 1
EP  - 7
VL  - ePub
IS  - ePub
N2  - 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 ("third delay") 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>
LA  - en
SN  - 0022-3085
UR  - http://dx.doi.org/10.3171/2018.8.JNS182182
ID  - ref1
ER  -