Neurosurgery Unit, Department of Surgery, Laquintinie Hospital, Douala, Cameroon; Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Faculty of Medicine, Higher Institute of Health Sciences, Université des Montagnes, Bangangte, Cameroon.
Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Faculty of Medicine, Bel Campus University of Technology, Kinshasa, DR Congo.
World Neurosurg. 2020 Jul;139:e774-e783. doi: 10.1016/j.wneu.2020.04.162. Epub 2020 May 4.
Although nontraumatic diseases affect fewer people than traumatic neurosurgical diseases, they require expertise more often. The authors sought to understand the barriers to nontraumatic neurosurgical diseases (NTNSDs) in a country with limited access to neurosurgical care.
This cross-sectional study with retrospective data collection was carried out in 2 Cameroonian reference hospitals for a year. Multiple imputations were used to generate data for the missing variables-death and discharge with sequelae. Bivariate relationships were evaluated using the chi-square and Mann-Whitney U tests. Odds ratios were equally calculated, and the results were considered significant for a P value <0.05.
NTNSDs represented 44.1% of neurosurgical activity. Our study included 177 patients with a mean age of 43.7 ± 21.2 years. More than half (53.1%) were female, 78% lived in a different region from that of the neurosurgical center, 18.1% had health insurance, 39.5% were referrals, and the mean symptom-to-admission delay was 409.0 ± 1301.7 days. Most (87%) of the patients had undergone at least 1 of the diagnostic examinations prescribed to them. Men (P = 0.029) and rural dwellers (P = 0.017) had shorter symptom-to-admission delays than women and urban dwellers, respectively. The mean length of stay was 18.2 ± 13.4, and 80.8% of patients were treated surgically. Thirty-one (17.5%) patients died in the hospital: 9 were treated surgically, and 22 were treated conservatively or expectantly.
Patients with NTNSD present at the definitive care facilities late. This delay is attributable to financial and geographic barriers.
尽管非创伤性神经外科疾病的患者人数少于创伤性神经外科疾病患者，但这些疾病往往需要更多的专业知识。作者旨在了解在一个神经外科治疗资源有限的国家中，非创伤性神经外科疾病（NTNSD）的障碍因素。
本研究为在喀麦隆两家参考医院进行的横断面研究，采用回顾性数据收集，为期一年。使用多重插补法对缺失变量（死亡和有后遗症的出院）生成数据。采用卡方检验和曼-惠特尼 U 检验评估二变量关系。计算比值比，P 值<0.05 时认为结果有统计学意义。
NTNSD 占神经外科活动的 44.1%。本研究纳入了 177 例患者，平均年龄为 43.7±21.2 岁。超过一半（53.1%）为女性，78%来自与神经外科中心不同的地区，18.1%有健康保险，39.5%为转诊患者，平均症状至入院时间延迟为 409.0±1301.7 天。大多数（87%）患者至少接受了一项规定的诊断检查。男性（P=0.029）和农村居民（P=0.017）的症状至入院时间延迟短于女性和城市居民。平均住院时间为 18.2±13.4 天，80.8%的患者接受了手术治疗。31 例（17.5%）患者在医院死亡：9 例接受了手术治疗，22 例接受了保守或期待治疗。
NTNSD 患者在到达确定性治疗机构时已经很晚了。这种延迟是由于经济和地理障碍造成的。
