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76 Traumatic brain injury surveillance in three low-middle income countries
  1. Corinne Peek-Asa
  1. University of Iowa, Injury Prevention Research Center


Traumatic Brain Injury (TBI) disproportionately affects Low and Middle-Income Countries (LMICs), which have higher incidence and poorer outcomes than high-income countries. TBI disproportionately affects the young, who have potential life-long disability from neurological deficits. Gaps in TBI data were identified by the World Health Organization as a priority in global TBI research. We report findings from the NIH-funded project, INITIatE: International Collaboration to increase Traumatic Brain Injury Surveillance in Europe, which established prospective TBI registries in eight hospitals in Armenia, Georgia and Moldova. These countries are in transition with improving health infrastructure but with acute care systems that lag behind international standards. A census of hospitals treating TBI patients was established, and the two highest volume hospitals treating adult and pediatric TBI in each country were selected. Prospective TBI registries in these six hospitals collected data from January 1 through June 30, 2019 for patients admitted with a TBI. The average age was 22 years and 66% were male. Falls (46%) were the most frequent mechanism of TBI, followed by road traffic injury (23%), struck by object (19%) and assault (7%). Emergency Department Glasgow Coma Scale (GSC) indicated severe injury (GCS 1 – 8) in 5% of patients, moderate injury (GCS 9 – 12) in 11%, and mild injury (GCS 13 – 15) in 84%. Over 74% of patients arrived at the hospital more than one hour after injury and 19% arrived after more than four hours. Moderate and severe TBI was associated with an increased time to definitive care. Discharge status measured by the EQ-5D indicated problems with mobility (9%), self-care (13%), unable to engage in usual activities (25%) pain/discomfort (50%), and anxiety (37%). Future efforts to improve pre-hospital care with a focus on reducing time to definitive care and increased rehabilitation services are priorities for these three LMICs.

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