Prevalence of Delayed Healthcare Presentation and Associated Factors in Patients with Predominantly Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Vollständiger Abstract

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Background/Objectives: Traumatic brain injury (TBI) is a global burden and a leading cause of death and disability worldwide. Delayed healthcare presentation is significantly associated with poor outcomes. This systematic review and meta-analysis aim to estimate the prevalence of delayed healthcare presentation in patients with traumatic brain injury, identify associated determinants, and synthesize evidence to inform strategies for early intervention and improved healthcare accessibility worldwide. Methods: A comprehensive electronic search was performed in PubMed and Google Scholar, including all studies published up to 1 July 2025. Eligible studies encompassed patients of any age diagnosed with mild, moderate, or severe TBI, with both the definitions of delayed presentation and TBI severity determined according to the criteria specified by each individual study. Risk of bias in the studies was assessed using the MINORS criteria for non-randomized studies and the Appraisal Tool for Cross-Sectional Studies (AXIS). All analyses were performed using OpenMeta [Analyst] software. Results: A total of 13 studies were included in the meta-analysis. The pooled analysis of 10 studies of participants presenting to healthcare after 24 h was 23.3% (95% CI 19.1–27.4%, I2 = 99.22%, p < 0.001). Across 8 studies that included participants aged 2 years or older, the pooled proportion presenting after 24 h was 18.7% (95% CI 13.8–23.6%, p < 0.001). Five studies enrolling infants younger than 2 years yielded a pooled delayed-presentation proportion of 19.8% (95% CI 14.6–25.0%, p < 0.001). However, the random-effects pooled proportion of participants who presented to healthcare within 24 h of head trauma was 78.0% (95% CI 73.7–82.2%, p < 0.001). Substantial heterogeneity was noted across all studies. Conclusions: This meta-analysis estimates the prevalence and evaluates the determinants of delayed healthcare presentation in patients with predominantly mild TBI, as moderate-to-severe injuries were substantially underrepresented in the included studies. Our results report several factors that contributed to the delayed presentation of TBI, including geographic, socioeconomic, and clinical factors. Additionally, it demonstrates the clinical characteristics of TBI involving timing, presenting symptoms, and injury mechanism.