# Lead times in the early management of traumatic brain injury: relation to geographic conditions and clinical outcomes in a nationwide Swedish registry study

## TL;DR

This study examines how quickly traumatic brain injury patients receive care in Sweden and finds that faster treatment times are linked to better outcomes, though severity of injury is a stronger predictor.

## Contribution

The study provides new insights into how geographic and hospital factors influence lead times and outcomes in traumatic brain injury management.

## Key findings

- Larger geographic catchment areas were associated with longer prehospital lead times but shorter times to first CT scans.
- Higher hospital caseloads correlated with longer times to first CT scans.
- Faster lead times were linked to lower mortality in univariate analysis but not after adjusting for injury severity.

## Abstract

Traumatic brain injury (TBI) patients are at risk of sudden deterioration, requiring timely diagnostics and treatment to prevent secondary cerebral injuries. This study investigated lead times in prehospital and early intrahospital TBI management, assessing their association with geographical conditions, hospital caseloads, and patient outcomes.

This nationwide, observational cohort study included 5036 TBI patients (during 2018–2022) from the Swedish Trauma Registry (SweTrau). Lead times from trauma to alarm, from alarm to hospital arrival, and times to first computed tomography (CT) from alarm and hospital arrival, respectively, were calculated. These were analyzed against the geographical distribution of healthcare, hospital caseloads, and 30-day mortality.

The majority of the cohort arrived in hospital within one hour and suffered a mild-to-moderate TBI. In univariate analyses, healthcare regions with larger geographical catchment areas exhibited longer time of prehospital management from alarm to arrival in hospital than smaller regions. Meanwhile, in multivariate linear regressions, larger region catchment area was independently associated with longer times from trauma to alarm and from alarm to hospital, but shorter time from alarm to first CT. In similar multivariate analyses, higher caseload was associated with longer time from alarm to first CT. Patients who were initially managed in a local hospital exhibited longer lead times overall, except from time to first CT from arrival in hospital. Furthermore, in the whole cohort, longer time from alarm to first CT and from arrival in hospital to first CT were associated with lower rate of mortality in univariate logistic regressions. However, this did not hold true in multivariate analysis after adjusting for demography and injury severity.

Lead times in TBI management varied by both geographical and hospital-bound factors. Faster lead times in TBI were associated with higher mortality in univariate analysis, but this association disappeared in multivariate analysis, suggesting that clinical severity rather than time alone is the stronger predictor of outcome. Nonetheless, it remains believed that efficient and qualitative management is a fundamental necessity for better outcomes in TBI management.