title: 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.
  
  
  METHODS
  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 low-financial 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Donka National Hospital, Conakry, Guinea ; Zeenat Qureshi Clinical Neurosciences Institute, Donka National Hospital, Conakry, Guinea.
authors.forename: Kézély
authors.initials: K
authors.lastname: Béavogui
authors.affiliation: Regional Health Observatory of French Guiana, Cayenne.
authors.forename: Akoï
authors.initials: A
authors.lastname: Koïvogui
authors.affiliation: Department of Neurosurgery, Donka National Hospital, Conakry, Guinea ; Zeenat Qureshi Clinical Neurosciences Institute, Donka National Hospital, Conakry, Guinea.
authors.forename: Tokpagnan Oscar
authors.initials: TO
authors.lastname: Loua
authors.affiliation: Department of Neurosurgery, Donka National Hospital, Conakry, Guinea.
authors.forename: Ramata
authors.initials: R
authors.lastname: Baldé
authors.affiliation: Department of Neurosurgery, Donka National Hospital, Conakry, Guinea.
authors.forename: Boubacar
authors.initials: B
authors.lastname: Diallo
authors.affiliation: Department of Neurosurgery, Donka National Hospital, Conakry, Guinea.
authors.forename: Aminata Rougui
authors.initials: AR
authors.lastname: Diallo
authors.affiliation: Department of Neurosurgery, Donka National Hospital, Conakry, Guinea.
authors.forename: Zézé
authors.initials: Z
authors.lastname: Béavogui
authors.affiliation: Department of Neurosurgery, Donka National Hospital, Conakry, Guinea.
authors.forename: Koué
authors.initials: K
authors.lastname: Goumou
authors.affiliation: Regional Health Observatory of French Guiana, Cayenne.
authors.forename: Vamala
authors.initials: V
authors.lastname: Guilavogui
authors.affiliation: Donka National Hospital, Conakry, Guinea; Ignace Deen National Hospital, Department of Neurology, Conakry, Guinea.
authors.forename: N'famara
authors.initials: N
authors.lastname: Sylla
authors.affiliation: Rubin Institute of Advanced Orthopedics, Sinai Hospital, Baltimore, Maryland.
authors.forename: Morad
authors.initials: M
authors.lastname: Chughtai
authors.affiliation: Zeenat Qureshi Clinical Neurosciences Institute, Donka National Hospital, Conakry, Guinea.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
authors.affiliation: Department of Neurosurgery, Donka National Hospital, Conakry, Guinea.
authors.forename: Aissatou Taran
authors.initials: AT
authors.lastname: Diallo
authors.affiliation: Department of Neurosurgery, Donka National Hospital, Conakry, Guinea.
authors.forename: Naby Daouda
authors.initials: ND
authors.lastname: Camara
keywords: Ability to finance care; delay to access to healthcare; hospital mortality; length of hospital stay; traumatic brain injury