Understanding Delays in CT Management for Traumatic Head Injuries: The Impact of Social Factors

Abstract

Background: Head injury is defined as any injury that causes lesion or functional damage to the cranium, meninges and brain.  It is an important cause of morbidity and mortality worldwide. Young males are mostly involved in cases of head injury, likely due to increased activity associated with this group. Common causes of head injury include road traffic accidents (RTA), assaults, and falls from height and stab wounds. In Nigeria, road traffic accidents are the leading cause of head injuries. Cranial CT has been established as an accurate and fast diagnostic imaging modality in the management of head injury. Many factors have been seen to affect the management of head injury with the leading factors being admission into a private/peripheral hospital lacking CT facility, followed by financial constraints.  Objective: The main goal of this study was to determine the major causes of delay in patients’ presentation for CT examination following head injury. Methodology: This was a prospective study of head injury patients referred for cranial CT evaluation at the Department of Radiology, NAUTH, Nnewi, carried out for a period of two years from 2017 to 2019. A total of 170 patients were involved in the study. A written informed consent was obtained from the patients or their relatives. The patients were scanned with a GE Bright speed 4-slice CT machine. Data Analysis: Data processing and statistical analysis was done using Statistical Package for the Social Sciences (SPSS), version 20.0. Socio-demographic and other relevant characteristics were displayed in tables and charts. Results: 77.6% of subjects in this study were males. The mean age of the patients was 34.31+ 21.08 years, with an age range of 6 months to 90 years. The modal age group affected was 21 – 30 years which constituted 23.5% of the study population. Motor-cycle road traffic accident (42.3%) was the most common mechanism of head injury seen in our setting, while sports-related injury (0.6%) was the least common mechanism of injury in this study. The leading social factor that causes delay in CT management of head injury is admission into a private/peripheral hospital lacking CT facility followed by cost of the investigation. Conclusion: The leading cause of delay to CT management of patients with head injury is admission into a private/peripheral hospital followed by financial constraints and other factors like the lack of awareness of the role of CT in the management of head injury by patients and their relatives, the fact that the few CT centers available are not easily accessible to many of the referring doctors and the pitiable transport facilities with unavailability of ambulance services.  Adequate awareness of role of CT and government intervention in subsidizing the cost in Government hospitals is advocated. We also recommend introducing targeted interventions in health care that will address health care access, health literacy, cultural beliefs and communication barriers. These measures in our health care systems can remarkably reduce these causes of delays, and improve the efficiency of care delivery for patients with traumatic head injury.