title: A double-edged sword: the effect of technological advancements in the management of neurotrauma patients.
abstract: BACKGROUND
  Despite South Africa's rapidly growing population, the number of patients evaluated by our trauma unit remains static. However, after presentation, increased delays in time to surgery is an issue. With a vast array of technological advancements having been implemented since 2008 at our institution, a clear problem exists at some stage of the patient management process. The aim of this study is to evaluate the efficacy of the management of neurotrauma patients and determine whether there is an association with technological advancements.
  
  
  METHODS
  An ambispective study was performed to assess the management of neurotrauma patients. A comparative timeline of 7 months (1 January to 31 July 2007 retrospectively and 1 January to 31 July prospectively 2015) was chosen to evaluate several parameters involved in the management of the neurotrauma patient and the factors affecting these. The year 2007 was chosen as this is the last year prior to implementation of technological improvements.
  
  
  RESULTS
  The demographics, age group and gender of the respective patient populations was remarkably similar. There was more rapid emergency medical service dispatch and hospital transfer in 2015. The time taken for a patient to get to computed tomography (CT) scan has increased and as has the time period between CT scanning and neurosurgical consultation. Time to ultimate neurosurgical intervention after referral, however, has decreased over the years.
  
  
  CONCLUSIONS
  One of the greatest sources of delay to surgical management seems to be due to delays in CT scanning where inappropriate prioritization of cases occurs as a result of abuse of the booking and lack of human decision-making and triage. Similarly, after hours needs are not being met with current CT services. As a result of the restriction of human involvement in terms of reviewing scan requests and results there are delays to the neurosurgical service.
authors.affiliation: a Division of Neurosurgery , Tygerberg Academic Hospital, Stellenbosch University , Cape Town , South Africa.
authors.forename: Iain
authors.initials: I
authors.lastname: Walker
authors.affiliation: a Division of Neurosurgery , Tygerberg Academic Hospital, Stellenbosch University , Cape Town , South Africa.
authors.forename: Adriaan Johannes
authors.initials: AJ
authors.lastname: Vlok
authors.affiliation: a Division of Neurosurgery , Tygerberg Academic Hospital, Stellenbosch University , Cape Town , South Africa.
authors.forename: Ameya
authors.initials: A
authors.lastname: Kamat
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D020811:Biomedical Technology / Q000639:trends*; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D019468:Disease Management; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D010360:Patient Transfer / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D013019:South Africa / Q000453:epidemiology; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome
keywords: Effect; neurotrauma; technological advancements