Traumatic Brain Injury Related to Motor Vehicle Accidents in Guinea: Impact of Treatment Delay, Access to Healthcare, and Patient's Financial Capacity on Length of Hospital Stay and in-hospital Mortality

Abstract

Background—Traumatic brain injury related to road traffic accidents poses a major challenge in
resource-poor settings within Guinea.
Objective—To analyze the impact of treatment delay, access to healthcare, and patient's financial capacity
on duration of hospital stay and in-hospital mortality.
Methodology—Data from patients with traumatic brain injury secondary to motor vehicle accident
admitted to a reference hospital (public or private) in Guinea during 2009 were analyzed. The association
between various factors (treatment delay, access to healthcare, and patient's financial capacity) and prolonged hospital stay (>21 days) and in-hospital mortality were analyzed using two multivariate logistic
regression models.
Results—The mean (±standard deviation) duration of hospital stay was 8.0 (±8.1) days. The risk of prolonged hospital stay increased by 60% when the time interval between accident and hospital arrival was
greater than 12 hours compared with those in whom the time interval was less than 6 hours (adjusted odds
ratio [OR] = 1.6, 95% confidence interval [CI] = 1.0–2.6, p = 0.03). Compared with patients with lowfinancial capacity, patients with medium-financial capacity (adjusted OR = 0.6, 95% CI = 0.4–0.8, p =
0.001) and those with high capacity (adjusted OR = 0.6, 95% CI = 0.4–0.9, p = 0.02) were less likely to
have a prolonged hospital stay. The risk of in-hospital mortality was 2.6 times higher in patients with time
interval between accident and hospital arrival greater than 12 hours compared with those in whom the time
interval was less than 6 hours (adjusted OR = 2.6, 95% CI = 1.1–6.2 p = 0.03). In-hospital mortality was
not related to patient’s financial capacity.
Conclusion—Prolonged hospital stay and higher in-hospital mortality was associated with longer time
interval between accident and hospital arrival. This delay is attributed to inadequate condition of intercity
roads and lack of emergency medical services