目的:进行了一项荟萃分析,以比较:(1)从创伤性脑损伤(TBI)到医院的时间,(2)在医院内进行干预或手术的时间,按国家一级的收入,世卫组织区域和医疗保健支付系统。
方法:进行了全面的文献检索,然后进行了荟萃分析,比较了TBI管理中(院前和院内)延误的持续时间。使用随机效应模型合并平均值和标准偏差,并使用R软件进行亚组分析。
结果:我们的分析包括来自45个国家的95,554例TBI患者。
■来自23个LMIC,从受伤到手术的平均时间更长(862.53分钟,CI:107.42-1617.63),院前(217.46分钟,CI:-27.34-462.25),和医院内部(166.36分钟,95%CI:96.12-236.60)的持续时间与22个HIC相比。
■非洲地区(AFR)的总数最大(1062.3分钟,CI:-1072.23-3196.62),院前(256.57分钟(CI:-202.36-715.51)),和医院内持续时间(593.22分钟,CI:-3546.45-4732.89)。
■多付款人卫生系统(MPHS)的院前住院时间更长(132.62分钟,CI:54.55-210.68),但在单付款人卫生系统(SPHS)中发现了更大的医院内延误(309.37分钟,CI:-21.95-640.69)。
结论:我们的研究得出结论,与HIC相比,AFR国家的LMIC中的TBI患者在院前和医院内管理方面面临长期的延误。此外,SPHS内的患者经历了长时间的院内延误.强调了解决神经创伤护理全球差异的迫切需要。
OBJECTIVE: A meta-analysis was conducted to compare: 1) time from traumatic brain injury (TBI) to the hospital, and 2) time within the hospital to intervention or surgery, by country-level income, World Health Organization region, and healthcare payment system.
METHODS: A comprehensive literature search was conducted and followed by a meta-analysis comparing duration of delays (prehospital and intrahospital) in TBI management. Means and standard deviations were pooled using a random effects model and subgroup analysis was performed using R software.
RESULTS: Our analysis comprised 95,554 TBI patients from 45 countries.
UNASSIGNED: From 23 low- and middle-income countries, a longer mean time from injury to surgery (862.53 minutes, confidence interval [CI]: 107.42-1617.63), prehospital (217.46 minutes, CI: -27.34-462.25), and intrahospital (166.36 minutes, 95% CI: 96.12-236.60) durations were found compared to 22 high-income countries.
UNASSIGNED: African Region had the greatest total (1062.3 minutes, CI: -1072.23-3196.62), prehospital (256.57 minutes [CI: -202.36-715.51]), and intrahospital durations (593.22 minutes, CI: -3546.45-4732.89).
UNASSIGNED: Multiple-Payer Health Systems had a greater prehospital duration (132.62 minutes, CI: 54.55-210.68) but greater intrahospital delays were found in Single-Payer Health Systems (309.37 minutes, CI: -21.95-640.69).
CONCLUSIONS: Our study concludes that TBI patients in low- and middle-income countries within African Region countries face prolonged delays in both prehospital and intrahospital management compared to high-income countries. Additionally, patients within Single-Payer Health System experienced prolonged intrahospital delays. An urgent need to address global disparities in neurotrauma care has been highlighted.