title: Emergency care of traumatic brain injuries in Pakistan: a multicenter study.
abstract: BACKGROUND
  This study assessed factors associated with emergency care outcomes and out-of-pocket treatment costs in traumatic brain injury (TBI) patients in Pakistan.
  
  
  METHODS
  Data 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.
  
  
  RESULTS
  ED 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).
  
  
  CONCLUSIONS
  TBI patients' access to ambulance transport, experienced physicians, and imaging facilities during emergency care needs to be improved in Pakistan.
authors.forename: Junaid
authors.initials: J
authors.lastname: Bhatti
authors.forename: Kent
authors.initials: K
authors.lastname: Stevens
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mir
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Hyder
authors.forename: Junaid
authors.initials: J
authors.lastname: Razzak
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000552:Ambulances / Q000706:statistics & numerical data; D001930:Brain Injuries / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005382:Financing, Personal; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D011159:Population Surveillance; D017678:Sex Distribution; D012959:Socioeconomic Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed; D055815:Young Adult