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  4. Time-to-treatment in traumatic brain injury: unraveling the impact of early surgical intervention on patient outcomes
 
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Time-to-treatment in traumatic brain injury: unraveling the impact of early surgical intervention on patient outcomes

Journal
Neurological Research
ISSN
0161-6412
1743-1328
Date Issued
2025
Author(s)
María Inés Egas Terán
González Andrade, Fabricio
Facultad de Ciencias de la Salud y Bienestar Humano
Type
journal-article
DOI
10.1080/01616412.2025.2515523
URL
https://cris.indoamerica.edu.ec/handle/123456789/9404
Abstract
Background: Traumatic brain injury (TBI) remains a major public health concern due to its high morbidity and mortality. The ‘golden hour’ principle suggests that outcomes improve with rapid access to definitive care. However, the role of prehospital transport time in TBI prognosis remains unclear, particularly in resource-limited settings. This study evaluates the relationship between hospital arrival time and functional prognosis in TBI patients. Methods: A cross-sectional observational study was conducted in two Ecuadorian trauma centers from 2017 to 2020. Patients were categorized into early (<8 h) and late (>8 h) hospital arrival groups. Demographic, clinical, radiological, and surgical variables were analyzed. The primary outcome was functional prognosis, measured by the Glasgow Outcome Scale (GOS) at hospital discharge. Logistic regression was used to adjust for confounding variables. Results: A total of 373 TBI patients were analyzed. The early-care group presented with more severe injuries, lower Glasgow Coma Scale (GCS) scores, and higher rates of abnormal pupillary responses. Late-arriving patients had better initial neurological status and were more likely to have received prehospital stabilization. Surgical intervention was delayed in both groups, with 67.8% of early-care patients undergoing surgery 8–24 h post-trauma. Adjusted analysis showed no significant difference in functional outcomes between early and late-care groups (OR 1.95, p = 0.08). Conclusion: Hospital arrival time alone does not significantly influence TBI outcomes. Instead, prehospital stabilization, initial GCS, and timely surgical intervention are stronger prognostic factors. Trauma care strategies should prioritize improving prehospital management and reducing in-hospital delays rather than strictly adhering to the ‘golden hour’ paradigm.
Subjects
  • Ecuador

  • Glasgow Outcome Scale...

  • golden hour

  • prehospital care

  • surgical timing

  • Traumatic brain injur...

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