{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T12:27:59Z","timestamp":1793795279086,"version":"4.6.1"},"reference-count":33,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Universidad Tecnol\u00f3gica Indoam\u00e9rica, Quito, Ecuador"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Traumatic brain injury (TBI) remains a critical public health issue worldwide, with significant morbidity, mortality, and long-term disability. Timely transfer to a specialized trauma unit is crucial to improving outcomes, yet in resource-limited settings, delays often exceed recommended time frames. This study evaluates the impact of arrival time on mortality, disability, and clinical outcomes in Ecuadorian patients with TBI. A cross-sectional and observational study was conducted, analyzing 383 adult patients diagnosed with TBI. Patients were categorized into two cohorts: those who arrived at a specialized trauma unit within five hours post-injury and those who arrived between five and 24 h. Demographic, clinical, and radiological characteristics were analyzed, including Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Marshall Scale classification, and presence of subarachnoid hemorrhage (SAH). Logistic regression models were used to identify predictors of mortality and disability. Longer transfer times were associated with increased mortality (3.34 times higher for \u22655 h, p &lt; 0.05) and disability (2.92 times higher for \u22655 h, p &lt; 0.05). Patients with Marshall Diffuse Injury III and IV had an 8.80- and 9.05-fold increased risk of mortality, respectively. SAH was an independent predictor of mortality (4.53 times higher), and GCS between 9\u201313 increased the likelihood of death by 6.49 times. Delayed transfers were associated with lower GCS at admission, longer ICU stays, and increased surgical complications. Although some survivors experienced improvement over time, disability in TBI can persist for many years or even lifelong, underscoring the burden of delayed trauma care. Despite delays, overall survival remained higher than reported in high-income countries, suggesting compensatory factors in hospital-based management. Delayed hospital arrival in TBI patients significantly increases mortality and disability. Early transfer within five hours is essential to reduce secondary brain injury and improve functional outcomes. Findings suggest that in resource-limited settings, optimizing pre-hospital care and transport efficiency is crucial to minimizing long-term disability.<\/jats:p>","DOI":"10.3390\/ijerph22101566","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T06:06:32Z","timestamp":1760508392000},"page":"1566","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Delayed Trauma Unit Admission on Mortality and Disability in Traumatic Brain Injury Patients"],"prefix":"10.3390","volume":"22","author":[{"given":"Julio","family":"Quispe-Alcocer","sequence":"first","affiliation":[{"name":"Health Sciences College, School of Medical Specialties, Universidad San Francisco de Quito USFQ, Diego de Robles Street s\/n and Pampite, Quito 170901, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Biroli","sequence":"additional","affiliation":[{"name":"Service of Neurosurgery, Hospital Eugenio Espejo, Av. Gran Colombia, Quito 170136, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2091-9095","authenticated-orcid":false,"given":"Fabricio","family":"Gonz\u00e1lez-Andrade","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud y Bienestar, Direcci\u00f3n de Posgrados en Salud, Universidad Tecnol\u00f3gica Indoam\u00e9rica, Calle Machala y Sabanilla, Quito 170301, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.1016\/S2468-2667(19)30188-4","article-title":"Traumatic brain injury in homeless and marginally housed individuals: A systematic review and meta-analysis","volume":"5","author":"Stubbs","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.3171\/2017.10.JNS17352","article-title":"Estimating the global incidence of traumatic brain injury","volume":"130","author":"Dewan","year":"2019","journal-title":"J. Neurosurg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1055\/s-0040-1701370","article-title":"Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP])","volume":"11","author":"Rubiano","year":"2020","journal-title":"J. Neurosci. Rural. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"234","DOI":"10.3171\/2017.3.JNS162720","article-title":"Clinical characteristics and temporal profile of recovery in patients with favorable outcomes at 6 months after severe traumatic brain injury","volume":"129","author":"Vedantam","year":"2018","journal-title":"J. Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5936345","DOI":"10.1155\/2019\/5936345","article-title":"Is Prehospital Time Important for the Treatment of Severely Injured Patients? A Matched-Triplet Analysis of 13,851 Patients from the TraumaRegister DGU\u00ae","volume":"2019","author":"Klein","year":"2019","journal-title":"Biomed. Res. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.injury.2012.01.011","article-title":"Redefining the golden hour for severe head injury in an urban setting: The effect of pre-hospital arrival times on patient outcomes","volume":"44","author":"Dinh","year":"2013","journal-title":"Injury"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1097\/TA.0b013e3182782675","article-title":"Patients with severe traumatic brain injury transferred to a Level I or II trauma center: United States, 2007 to 2009","volume":"73","author":"Sugerman","year":"2012","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_8","first-page":"e80657","article-title":"Clinical Epidemiology of Trauma Patients: A Retrospective Analysis of 3705 Consecutive Patients Treated at a Level I Trauma Center","volume":"17","author":"Singh","year":"2025","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1007\/s00268-009-0266-1","article-title":"Epidemiology of traumatic deaths: A comprehensive population-based assessment","volume":"34","author":"Evans","year":"2010","journal-title":"World J. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1227\/NEU.0000000000001432","article-title":"Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition","volume":"80","author":"Carney","year":"2017","journal-title":"Neurosurgery"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1001\/jamasurg.2016.3329","article-title":"Evaluation of Rural vs. Urban Trauma Patients Served by 9-1-1 Emergency Medical Services","volume":"152","author":"Newgard","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1080\/10903127.2018.1448494","article-title":"Analysis of Prehospital Scene Times and Interventions on Mortality Outcomes in a National Cohort of Penetrating and Blunt Trauma Patients","volume":"22","author":"Ruelas","year":"2018","journal-title":"Prehospital Emerg. Care"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"CRASH-3 Trial Collaborators (2019). Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): A randomized, placebo-controlled trial. Lancet, 394, 1713\u20131723.","DOI":"10.1016\/S0140-6736(19)32233-0"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1186\/s13063-017-2073-6","article-title":"A nested mechanistic sub-study into the effect of tranexamic acid versus placebo on intracranial haemorrhage and cerebral ischaemia in isolated traumatic brain injury: Study protocol for a randomised controlled trial (CRASH-3 Trial Intracranial Bleeding Mechanistic Sub-Study [CRASH-3 IBMS])","volume":"18","author":"Mahmood","year":"2017","journal-title":"Trials"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Rubenson Wahlin, R., Nelson, D.W., Bellander, B.M., Svensson, M., Helmy, A., and Thelin, E.P. (2018). Pre-hospital Intubation and Outcome in Traumatic Brain Injury-Assessing Intervention Efficacy in a Modern Trauma Cohort. Front. Neurol., 9.","DOI":"10.3389\/fneur.2018.00194"},{"key":"ref_16","first-page":"171","article-title":"Management of severe traumatic brain injury (first 24 hours)","volume":"37","author":"Geeraerts","year":"2018","journal-title":"Aaesthesia Crit. Care Pain Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.amj.2019.06.001","article-title":"Prehospital Airway Management in Severe Traumatic Brain Injury","volume":"38","author":"Gamberini","year":"2019","journal-title":"Air Med. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1080\/10903127.2019.1575498","article-title":"Effect of Physician-Staffed Emergency Medical Services (P-EMS) on the Outcome of Patients with Severe Traumatic Brain Injury: A Review of the Literature","volume":"23","author":"Popal","year":"2019","journal-title":"Prehospital Emerg. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1089\/neu.2006.0029","article-title":"Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: An IMPACT analysis","volume":"24","author":"Marmarou","year":"2007","journal-title":"J. Neurotrauma"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.acra.2014.01.017","article-title":"Early CT findings to predict early death in patients with traumatic brain injury: Marshall and Rotterdam CT scoring systems compared in the major academic tertiary care hospital in northeastern Japan","volume":"21","author":"Mugikura","year":"2014","journal-title":"Acad. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Shan, Y., Li, Y., Xu, X., Feng, J., Wu, X., and Gao, G. (2021). Evaluation of Intracranial Hypertension in Traumatic Brain Injury Patient: A Noninvasive Approach Based on Cranial Computed Tomography Features. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112524"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1089\/neur.2020.0004","article-title":"Polytrauma Is Associated with Increased Three- and Six-Month Disability after Traumatic Brain Injury: A TRACK-TBI Pilot Study","volume":"1","author":"Yue","year":"2020","journal-title":"Neurotrauma Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1055\/s-0041-1726623","article-title":"Development of a Prognostic Model to Predict Mortality after Traumatic Brain Injury in Intensive Care Setting in a Developing Country","volume":"12","author":"Jayan","year":"2021","journal-title":"J. Neurosci. Rural. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s13049-020-00828-4","article-title":"Physician-led pre-hospital management is associated with reduced mortality in severe blunt trauma patients: A retrospective analysis of the Japanese nationwide trauma registry","volume":"29","author":"Endo","year":"2021","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S117","DOI":"10.1016\/j.wem.2017.02.008","article-title":"Managing Traumatic Brain Injury: Translating Military Guidelines to the Wilderness","volume":"28","author":"Otten","year":"2017","journal-title":"Wilderness Environ. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.injury.2015.01.008","article-title":"The influence of pre-hospital time on trauma patients outcome: A systematic review","volume":"46","author":"Harmsen","year":"2015","journal-title":"Injury"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/j.suc.2017.06.001","article-title":"Assessment and Resuscitation in Trauma Management","volume":"97","author":"Gondek","year":"2017","journal-title":"Surg. Clin. N. Am."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e022279","DOI":"10.1136\/bmjopen-2018-022279","article-title":"Impact of the SIGN head injury guidelines and NHS 4-hour emergency target on hospital admissions for head injury in Scotland: An interrupted times series","volume":"8","author":"Marincowitz","year":"2018","journal-title":"BMJ Open"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chen, C.-H., Shin, S.D., Sun, J.-T., Jamaluddin, S.F., Tanaka, H., Song, K.J., Kajino, K., Kimura, A., Huang, E.P.-C., and Hsieh, M.-J. (2020). Association between pre-hospital time and outcome of trauma patients in 4 Asian countries: A cross-national, multicenter cohort study. PLoS Med., 17.","DOI":"10.1371\/journal.pmed.1003360"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1080\/10903127.2018.1551451","article-title":"Longer Prehospital Time was not Associated with Mortality in Major Trauma: A Retrospective Cohort Study","volume":"23","author":"Brown","year":"2019","journal-title":"Prehospital Emerg. Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e028912","DOI":"10.1136\/bmjopen-2019-028912","article-title":"Evaluation of the impact of the NICE head injury guidelines on inpatient mortality from traumatic brain injury: An interrupted time series analysis","volume":"9","author":"Marincowitz","year":"2019","journal-title":"BMJ Open"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12245-020-00324-7","article-title":"A scoping review of worldwide studies evaluating the effects of pre-hospital time on trauma outcomes","volume":"13","author":"Bedard","year":"2020","journal-title":"Int. J. Emerg. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.1016\/j.wneu.2019.02.019","article-title":"Injury-to-Admission Delay Beyond 4 Hours Is Associated with Worsening Outcomes for Traumatic Brain Injury in Cambodia","volume":"126","author":"Spaggiari","year":"2019","journal-title":"World Neurosurg."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/10\/1566\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T06:16:00Z","timestamp":1760508960000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/10\/1566"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,15]]},"references-count":33,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["ijerph22101566"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22101566","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,15]]}}}