Time to Care: Analysis of Time Differences and Outcomes in the Management of Pediatric Traumatic Brain Injury for a High-Income and Lower-Middle-Income Country

Myron L Rolle; Juan Silvestre G Pascual; Ashley L Williams; Timothy West; Rachel McLellan; Kathleen Joy O Khu; Ronnie E Baticulon; Ann-Christine Duhaime

doi:10.1016/j.wneu.2023.04.094

Time to Care: Analysis of Time Differences and Outcomes in the Management of Pediatric Traumatic Brain Injury for a High-Income and Lower-Middle-Income Country

World Neurosurg. 2023 Apr 28:S1878-8750(23)00580-6. doi: 10.1016/j.wneu.2023.04.094. Online ahead of print.

Authors

Myron L Rolle¹, Juan Silvestre G Pascual², Ashley L Williams³, Timothy West⁴, Rachel McLellan⁴, Kathleen Joy O Khu², Ronnie E Baticulon², Ann-Christine Duhaime⁴

Affiliations

¹ Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA. Electronic address: MROLLE@partners.org.
² Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines.
³ Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA; Columbia University Mailman School of Public Health, New York, New York, USA.
⁴ Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.

PMID: 37121503
DOI: 10.1016/j.wneu.2023.04.094

Abstract

Background: Pediatric cranial trauma is the leading cause of acquired death and disability in children worldwide. However, trauma resources vary widely among countries. We sought to compare management and timely access to care between a level 1 U.S. pediatric trauma center and a tertiary referral hospital in a lower-middle-income country to assess whether system and resource differences influence care and outcomes.

Methods: We compared data from 214 pediatric head trauma admissions to Philippine General Hospital (Manila) with 136 children from the TRACK-TBI pediatrics study cohort at Massachusetts General Hospital (MGH). Admitted MGH patients were compared with the Philippine cohort regarding demographics; mechanism of injury; times to neurosurgical consult, imaging, and surgery; in-hospital mortality; and length of hospitalization.

Results: Age (9 years), gender distribution (67% male), and presenting Glasgow Coma Scale scores were similar (P = 0.10) between sites. More children had intracranial injury in the Philippine cohort (73% vs. 60%; n = 319) and more underwent neurosurgery (27% vs. 4%). Times to consult, imaging, and surgery were longer in the Philippines (12.3 vs. 6.5, 12.0 vs. 2.8, and 45.4 vs. 5.6 hours, respectively). In-hospital mortality across all admissions was similar between cohorts (3% vs. 0%; P = 0.09), but significantly higher in the most severe Philippines cases (31% vs. 0%, P=0.04). Length of stay was longer (5 vs. 2 days; P < 0.001) in the Philippine cohort.

Conclusions: High-income country status correlated with faster care, shorter hospitalizations, and better outcomes among severe cases. Prompt care through sophisticated trauma system implementation may improve pediatric health in resource-limited settings.

Keywords: Delays; LMIC; Pediatric traumatic brain injury; TBI.