An Assessment of Global Neurotrauma Prevention and Care Delivery: The Provider Perspective.

Abstract Introduction Neurotrauma is one of the leading causes of morbidity and mortality around the world. Assessment of injury prevention and pre-hospital care for neurotrauma patients is necessary to improve care systems. Methods A 29-question electronic survey was developed based on the EQUATOR checklist to assess neurotrauma policies and laws related to safety precautions. The survey was distributed to members of WHO regions that were considered to be experienced medical authorities in neurosurgery and traumatic brain injury (TBI). Results There were 82 (39%) responses, which represented 46 different countries. Almost all respondents (95.2%) were within the neurosurgical field. 40.2% of respondents were from HICs and 59.8% from LMICs. Motor vehicle accidents (MVAs) were reported as the leading cause of neurotrauma, with workplace injury ranking second, and assault third. 84.1% of respondents reported having a helmet law in their country. HICs (4.38 ±0.78) were ranked more likely than LMICs (2.88 ±1.34, p=0.0001) to enforce helmet laws, on a scale of 1-10. The effectiveness of helmet laws was rated as 3.94 ±0.95 out of 10, on average. Measures regarding pre-hospital care varied between HICs and LMICs. Patients in HICs were more likely to utilize public emergency ambulance transportation (81.8% vs 42.9%; p=0.0004). The presence of all pre-hospital personnel having emergency training was also reported to be more likely in HICs than LMICs (60.6% vs 8.7%, p=0.0001). Conclusion When injuries occur, timely access to neurosurgical care is critical and requires improvement of all aspects of the system. Accordingly, a focus on pre-hospital components of the trauma system is paramount, and policymakers can utilize the information here to implement and refine healthcare systems that will ensure safe, timely, affordable, and equitable access to neurotrauma care.