Impact of Delayed Trauma Unit Admission on Mortality and Disability in Traumatic Brain Injury Patients

Julio Quispe-Alcocer, Antonio Biroli and Fabricio González-Andrade ()
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Julio Quispe-Alcocer: Health Sciences College, School of Medical Specialties, Universidad San Francisco de Quito USFQ, Diego de Robles Street s/n and Pampite, Quito 170901, Ecuador
Antonio Biroli: Service of Neurosurgery, Hospital Eugenio Espejo, Av. Gran Colombia, Quito 170136, Ecuador
Fabricio González-Andrade: Facultad de Ciencias de la Salud y Bienestar, Dirección de Posgrados en Salud, Universidad Tecnológica Indoamérica, Calle Machala y Sabanilla, Quito 170301, Ecuador

IJERPH, 2025, vol. 22, issue 10, 1-11

Abstract: Traumatic brain injury (TBI) remains a critical public health issue worldwide, with significant morbidity, mortality, and long-term disability. Timely transfer to a specialized trauma unit is crucial to improving outcomes, yet in resource-limited settings, delays often exceed recommended time frames. This study evaluates the impact of arrival time on mortality, disability, and clinical outcomes in Ecuadorian patients with TBI. A cross-sectional and observational study was conducted, analyzing 383 adult patients diagnosed with TBI. Patients were categorized into two cohorts: those who arrived at a specialized trauma unit within five hours post-injury and those who arrived between five and 24 h. Demographic, clinical, and radiological characteristics were analyzed, including Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Marshall Scale classification, and presence of subarachnoid hemorrhage (SAH). Logistic regression models were used to identify predictors of mortality and disability. Longer transfer times were associated with increased mortality (3.34 times higher for ≥5 h, p < 0.05) and disability (2.92 times higher for ≥5 h, p < 0.05). Patients with Marshall Diffuse Injury III and IV had an 8.80- and 9.05-fold increased risk of mortality, respectively. SAH was an independent predictor of mortality (4.53 times higher), and GCS between 9–13 increased the likelihood of death by 6.49 times. Delayed transfers were associated with lower GCS at admission, longer ICU stays, and increased surgical complications. Although some survivors experienced improvement over time, disability in TBI can persist for many years or even lifelong, underscoring the burden of delayed trauma care. Despite delays, overall survival remained higher than reported in high-income countries, suggesting compensatory factors in hospital-based management. Delayed hospital arrival in TBI patients significantly increases mortality and disability. Early transfer within five hours is essential to reduce secondary brain injury and improve functional outcomes. Findings suggest that in resource-limited settings, optimizing pre-hospital care and transport efficiency is crucial to minimizing long-term disability.

Keywords: mortality; disability; clinical results; Brain trauma injury; arrival time at the hospital; Ecuador (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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