Factors delaying the continuum of care for the management of traumatic brain injury in low- and-middle income countries: A systematic review

Background: Considering the disproportionate burden of delayed traumatic brain injury (TBI) management in low-and-middle income countries (LMICs), there is pressing demand for investigations. Therefore, our study aims to evaluate factors delaying the continuum of care for the management of TBIs in LMICs.Methods: A systematic review was conducted with PubMed, Scopus, Google Scholar and CINAHL (Cumulative Index to Nursing and Allied Health Literature). Observational studies with TBI patients in LMIC were included. The factors affecting management of TBI were extracted and analyzed descriptively.Results: A total of 55 articles were included consisting of 60,603 TBI cases from 18 LMICs. Road traffic accidents (58.7%) were the most common cause of injury. Among included studies, factors contributing to pre-hospital delays included a poor referral system and lack of an organized system of referral (14%), long travel distances (11%), inadequacy of emergency medical services (16.6%) and self-treatment practices (2.38%). For in-hospital delays, factors such as lack of trained physicians (10%), improper triage systems (20%), and absence of imaging protocols (10%), lack of in-house CT scanners (35%), malfunctioning CT scanners (10%), and a lack of invasive monitoring of intracranial pressure (5%), limited theater space (28%), lack of in-house neurosurgical facilities (28%), absence of in-house neurosurgeons (28%) and financial constraints (14%) were identified.Conclusions: Several factors both before and during hospitalization contribute to delays in the management of TBIs in LMICs. Strategically addressing these factors can help overcome delays and improve TBI management in LMICs