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Abstract Details

Addressing The Traumatic Brain Injury Crisis In Thailand: Analysis Of National Access To Neurosurgical Facilities Utilizing Geospatial Mapping
General Neurology
P1 - Poster Session 1 (8:00 AM-9:00 AM)
  • Road traffic injuries are among the leading causes of death in Thai youth. TBI accounts for 65% of all motorcycle-crash fatalities. In recent years, the proportion of TBI patients has more than doubled, resulting in excessive burden of disease currently unmet by epidemiological strategy.
  • We aim to assess the accessibility to neurosurgical centers in Thailand for the management of traumatic brain injury (TBI) using a novel approach of geospatial mapping in low-middle income countries. Additionally, we seek to address issues of priority setting in hospital site selection accounting for national insurance schemes.
  • Mapping neurosurgical accessibility in 77 provinces using population level data, spatial ancillary data, and reverse geocoding was conducted using ArcGIS. Mock-scenarios in which patients would have to be transferred to other hospital sites per the national insurance scheme were also assessed for the top-10 provinces with highest burden of disease. 
  • The percentage of the population with access to a neurosurgical facility within the golden hour is 22.6%, with the greatest disparity occurring in the northern border regions, where access time averages 180 minutes and only 12.3% of the population has access to neurosurgical care. Mock-scenarios analysis revealed that the current allocation of provincial hospital care accessible to a patient injured in a region to which they do not have access results in 78.2% excess delayed care.
  • With nearly 54 million people living too far away from a neurosurgical facility, that equates to 15,410 unnecessary deaths, given Thailand's high rate of mortality for TBI patients. The limitations of addressing this epidemiological gap include a lack of a national ambulance system with protocolized approaches to TBI management, brain-drain of neurosurgeons, and a lack of 24/7 neurosurgical care, which suggests that our findings may show an even larger disparity of care.
Arnav Mahajan
Mr. Mahajan has nothing to disclose.
Wuttipong Tirakotai No disclosure on file