1019 Evaluation of Barriers and Facilitators to Neurosurgical Access in Patients With Traumatic Brain Injury: An Explanatory Sequential Mixed-Methods Formative Implementation Study Using the Determinants Framework in Freetown, Sierra Leone

INTRODUCTION: Traumatic brain (TBI) is the leading cause of death in global trauma. Research on global burden of TBI remain sparse as 89% of these traumas occur in low to middle-income countries (LMICs) where scientific research is limited (Rubiano et al., 2015). METHODS: The study will utilize a explanatory sequential mixed methods study design. TBI prevalence, fidelity markers and outcomes are retrospectively calculated. Semi-structured interviews will be designed based on the outcomes of quantitative data analysis using descriptive statistics. RESULTS: Preliminary data documents 1,185 neurosurgical patients at Connaught Hospital between 2020-2022. 658 (55.5%) were treated for a traumatic brain injury. Road traffic accident is the most common etiology, many of which were pedestrian injuries and unhelmeted motorcyclists. Management of most TBI patients was by the orthopedic surgery service. The care cascade described for Connaught Hospital lack fidelity in execution; only 24% of ordered X-rays, 25% of ordered CT scans, and 17% of ordered MRIs were documented as completed. Qualitative analysis using the comprehensive framework for implementation research is likely to reveal multi-domain barriers focusing on relative advantage and tailored techniques that impact fidelity. Domains on internal and external influences including hospital culture, socio-economic discrepancies, road laws and policy and tensions for change will likely point to patient and environmental determinants contributing to TBI. CONCLUSIONS: TBI in LMICs are multi-factorial, contributed not only by patient factors, but by external policy, medical culture and socio-economics. Interventions to minimize TBI must look beyond individual personal protection and focus more on health systems and policy strengthening to create sustainable clinical impact.