From arrival to operating room: Investigating temporal gaps in neurosurgical care and management for traumatic brain injury patients at a tertiary care center in Pakistan

Objective: To evaluate temporal delays in the continuum of neurosurgical care in patients with traumatic brain injury (TBI) and determine their association with in-hospital mortality and injury severity. Methodology: This prospective observational cohort study was conducted at the Department of Neurosurgery, Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan from September 2025 to March 2026. Patients were stratified into TBI subgroups (mild, moderate, and severe based on Glasgow Coma Scale, GCS), and time from accident to management was divided into four intervals. Kruskal-Wallis test was used to compare TBI inter-group differences in time intervals. Mann-Whitney U test was applied to show the intra-group differences in mortality across time intervals for each individual TBI subgroup. Binary logistic regression to explore the independent predictors of in-hospital mortality. Results: A total of 220 patients were included, predominantly male (79.50%, 175) with a mean age of 37.06 ± 18.68 years. The median interval from injury to definitive management was 13.77 (IQR: 11.7516.50, mean±SD: 16.70±14.06) hours. Patients with moderate TBI experienced significantly longer delays between neurosurgical evaluation and definitive management than those with severe TBI (p = 0.045). Time stratification across TBI subgroups revealed that progressive, significant time continuums shortened as the injury severity increased. Low GCS at admission was the only significant predictor (adjusted OR: 0.775, 95%CI: 0.708-0.849, p<0.001) of in-hospital mortality. Conclusion: Temporal delays were shorter among patients with severe TBI, likely reflecting clinical prioritization. In contrast, among patients with moderate TBI, significantly longer delays between neurosurgical evaluation and definite management were observed in association with in-hospital mortality. GCS at admission remained the strongest independent predictor of mortality.