Abstract

BackgroundThis study assessed factors associated with emergency care outcomes and out-of-pocket treatment costs in traumatic brain injury (TBI) patients in Pakistan.MethodsData on TBI patients were extracted from a four-month surveillance study conducted in the emergency departments (ED) of seven large teaching hospitals. Emergency care access to physicians and imaging facilities were compared with respect to ED outcomes (discharged, admitted or dead). Out-of-pocket treatment costs (in United States dollars [USD]) were compared among different patient strata.ResultsED outcomes were available for 1,787 TBI patients. Of them, most were males (79%), aged <25 years (46%) and arrived by ambulances (32%). Nurses or paramedical staff saw almost all patients (95%). Physicians with practice privileges (medical officers, residents or consultants) saw about half (55%) of them. Computerized tomography (CT) scans were performed in two of five patients (40%). Of all, 26% (n = 460) were admitted and 3% died (n = 52). Emergency care factors significantly associated with being admitted or died were arriving by ambulance (adjusted odds ratio [aOR] = 2.37, 95% confidence interval (CI) [95%CI] = 1.78-3.16); seen by medical officer/residents (aOR = 2.11; 95%CI = 1.49-2.99); and had CT scan (aOR = 2.93; 95%CI = 2.25-3.83). Out-of-pocket treatment costs at the ED were reported in 803 patients. Average costs were USD 8, (standard deviation [SD] = 23). Costs were twice as high in those arriving in ambulances (USD 20, SD = 49) or who underwent CT scans (USD 16, SD = 37).ConclusionTBI patients' access to ambulance transport, experienced physicians, and imaging facilities during emergency care needs to be improved in Pakistan.

Highlights

  • This study assessed factors associated with emergency care outcomes and out-of-pocket treatment costs in traumatic brain injury (TBI) patients in Pakistan

  • This study evaluated factors associated with emergency care outcomes and out-of-pocket treatment costs in TBI patients in Pakistan [22,23,24]

  • Nearly 12,125 patients had presenting complaints as TBI, but the nature of the TBI was documented in only 2,179 patients

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Summary

Introduction

This study assessed factors associated with emergency care outcomes and out-of-pocket treatment costs in traumatic brain injury (TBI) patients in Pakistan. Emergency care plays a pivotal role in any healthcare system [1]. Effective emergency care systems can significantly reduce the risks of mortality and morbidity [2]. Emergency care outcomes for similar severe injuries can be significantly worse in low- and middle-income countries (LMICs) than in high-income countries (HICs) [2,3]. There are few studies on the emergency care quality in treating severe injuries [4]. The World Health Organization (WHO) resolution 60.22 calls all member nations to conduct evaluations in order to inform priorities in emergency care [5]

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