Determinants of Timing of Presentation of Neurotrauma Patients to a Neurosurgical Center in a Developing Country

Malomo, Toluyemi Adefolarin; Oyemolade, Toyin Ayofe; Adeleye, Amos Olufemi · 2018 · Crossref

DOI: 10.4103/jnrp.jnrp_502_17

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Summary

This study investigates the determinants of delayed presentation for neurotrauma patients seeking care at a specialized neurosurgical center in Nigeria, a developing country where late arrival is common and contributes to poor outcomes. The research was motivated by the critical need to prevent secondary neuronal injuries, which are time-sensitive and often irreversible, and by the observation that delays in transfer from primary care facilities significantly hinder effective management of traumatic brain and spinal cord injuries. The researchers conducted a prospective cross-sectional study over four months (July–October 2016) at the University College Hospital in Ibadan, a major referral center in southwestern Nigeria. They analyzed data from 111 consecutive neurotrauma patients, collecting information on biodata, injury characteristics, initial care received before referral, and the timing and causes of delays. Head injuries were classified using the Glasgow Coma Scale, and spinal cord injuries were graded using the American Spinal Injury Association scale. Data were analyzed using descriptive statistics via SPSS software. The results revealed that 80.2% of patients were male, with the majority aged 21–40 years. Road traffic accidents accounted for 73.9% of injuries, followed by falls (14.4%). Only 33.3% of patients presented within the critical four-hour window post-injury, while 53.2% presented after 12 hours. The majority of patients (83.8%) were referrals from other facilities, primarily private hospitals, rather than presenting directly from the trauma site. Among referred patients, 81.7% experienced delays. The primary determinants of this delay included late referral decisions by primary care providers, long-distance travel to the specialized center, and financial constraints due to out-of-pocket payment systems. Additionally, 86% of patients were transported by relatives rather than emergency medical services. The study concludes that delayed referral from primary care is a prominent factor in the late presentation of neurotrauma patients in Nigeria. The authors identify infrastructural deficits, such as poor road networks and lack of emergency ambulance services, as well as decision-making delays at primary facilities and financial barriers, as key contributors. They emphasize the need for improved collaboration and continuing medical education between neurosurgical specialists and primary care physicians to facilitate earlier identification and transfer of patients. Addressing these modifiable factors is presented as essential for reducing mortality and morbidity associated with neurotrauma in low-resource settings.

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• post crash care delays