1419. Prehospital Care for TBI in Cambodia
Authors: Ernest Barthelemy, MD; Riccardo Spaggiari; Jacquelyn Corley, MD; Jacob Lepard, MD; Steven Staffa, MS; Franco Servadei, MD; Kee Park, MD (New York, NY)
Introduction: In low-and-middle-income countries (LMICs), the prototypical traumatic brain injury(TBI) patient is a young male victim of motor vehicle collision. This demographic profile is particularly alarming for LMICs like Cambodia, where the economic productivity of young men is vital to socioeconomic development. We report a retrospective analysis of prehospital delays among TBI patients from a large government hospital in Cambodia. Methods: Demographic and clinical data was collected from 3476 TBI patients admitted to a major government hospital in Phnom Penh, Cambodia from 6/2013-to-6/2018. Patients with missing data, or admitted >12 hours post-injury were excluded. Statistical analyses were performed to examine associations between injury-to-admission delay (IAD) and GOS, likelihood of surgery, and hospital of length of stay (LOS). Results: 2335 TBI patients (77.3%male) were included. Median age was 27 years (IQR: 22,37). According to the injury severity at presentation, 1546 (66%) were mild, 509 (22%) were moderate and 264 (11%) were severe. No GCS data was available for 16 (1%) patients. We found an inverse relationship between IAD and GOS, most evidently for mild and moderate TBI (n=2055;88%). Logistic regression revealed that decrease in GOS was most apparent at IAD>4-hour threshold. Each 30-minute delay in IAD was correlated with >2-hour increase in LOS for mild (p<0.001) and moderate TBI (P<0.001), and an overall increase in odds of surgery was observed with increasing IAD across time intervals (OR=1.02,95% CI:1.00-1.04,p=0.030). Conclusion: In a retrospective cohort of >2300 TBI patients from Cambodia, we found that increasing IAD was associated with worsening neurological outcome, higher likelihood of surgery, and increased LOS. These data should inform development of prehospital guidelines for TBI care in LMICs.