TITLE:
Lesion Mapping and Determinants of Surgical Performance after Traumatic Brain Injury at Bouaké University Hospital (Côte d’Ivoire): Analysis of a Consecutive Hospital Series of 772 Patients
AUTHORS:
Koffi Yves Soress Dongo, Faozo Stephane Landry Teti, Konan Serge Yao, Kouadio Jean-Baptiste Keke, Yao Bernard Fionko, Aderehime Haidara
KEYWORDS:
Health Services Accessibility, Referral and Consultation, Neurosurgical Procedures, Craniocerebral Trauma
JOURNAL NAME:
World Journal of Neuroscience,
Vol.16 No.4,
October
28,
2026
ABSTRACT: Background: In resource-limited settings, access to neurosurgical treatment after traumatic brain injury (TBI) depends on the entire referral chain as much as on the lesion itself. Few studies map lesion subtypes while simultaneously analysing, within a single series, the pathway linking the recorded surgical indication to the operation actually performed. Objective: To identify factors independently associated with the absence of documented surgery among patients with a recorded surgical indication and, secondarily, to map six focal-lesion subtypes and analyse admission delays. Patients and Methods: Analytical observational study of a consecutive hospital series of 772 patients with TBI admitted to the neurosurgery department of Bouaké University Hospital between 2025 and 2026, reported in accordance with STROBE. All admitted patients with a usable record were included. The primary endpoint was the documented performance of an operation, defined as the entry of at least one trauma-related neurosurgical procedure in the operating register of the index admission, expressed relative to all recorded indications. All multivariable models used Firth penalised logistic regression with profile-likelihood confidence intervals. Results: Patients were young (median age 30 years), predominantly male (83.8%) and mostly injured in road-traffic crashes (89.4%); 389 (50.4%) were referred from another facility. Focal subtypes showed a marked age gradient, from 23 years for depressed skull fracture to 56 years for chronic subdural haematoma, confirmed among patients with a single isolated lesion (Kruskal-Wallis p Conclusion: Lesion subtype governed both the surgical indication and its documented performance. Beyond the lesion, referral from another facility was associated with a lower probability that an indicated operation would be performed, pointing to the referral chain, rather than lesion severity, as the modifiable target.