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Association of traumatic brain injury severity and time to definitive care in three low-middle-income European countries
  1. Corinne Peek-Asa1,
  2. Madalina Adina Coman2,
  3. Alison Zorn3,
  4. Nino Chikhladze4,
  5. Serghei Cebanu5,
  6. Artashes Tadevosyan6,
  7. Cara J Hamann1
  1. 1 Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
  2. 2 Public Health, Babes-Bolyai University Faculty of Political Administrative and Communication Sciences, Cluj-Napoca, Cluj, Romania
  3. 3 Biostatistics, University of Iowa, Iowa City, Iowa, USA
  4. 4 Public Health, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
  5. 5 Department of Hygiene, Moldova State University, Chisinau, Moldova (the Republic of)
  6. 6 Department of Public Health and Healthcare Organization, Yerevan State Medical University, Yerevan, Armenia
  1. Correspondence to Dr Corinne Peek-Asa, Occupational and Environmental Health, Iowa Board of Regents, Urbandale, IA 52242, USA; corinne-peek-asa{at}


Background Low-middle-income countries experience among the highest rates of traumatic brain injury in the world. Much of this burden may be preventable with faster intervention, including reducing the time to definitive care. This study examines the relationship between traumatic brain injury severity and time to definitive care in major trauma hospitals in three low-middle-income countries.

Methods A prospective traumatic brain injury registry was implemented in six trauma hospitals in Armenia, Georgia and the Republic of Moldova for 6 months in 2019. Brain injury severity was measured using the Glasgow Coma Scale (GCS) at admission. Time to definitive care was the time from injury until arrival at the hospital. Cox proportionate hazards models predicted time to care by severity, controlling for age, sex, mechanism, mode of transportation, location of injury and country.

Results Among 1135 patients, 749 (66.0%) were paediatric and 386 (34.0%) were adults. Falls and road traffic were the most common mechanisms. A higher proportion of adult (23.6%) than paediatric (5.4%) patients had GCS scores indicating moderate (GCS 9–11) or severe injury (GCS 0–8) (p<0.001). Less severe injury was associated with shorter times to care, while more severe injury was associated with longer times to care (HR=1.05, 95% CI 1.01 to 1.09). Age interacted with time to care, with paediatric cases receiving faster care.

Conclusions Implementation of standard triage and transport protocols may reduce mortality and improve outcomes from traumatic brain injury, and trauma systems should focus on the most severe injuries.

  • traumatic brain injury
  • registry
  • global

Data availability statement

Deidentified and concatenated data can be available from the corresponding author on request.

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Data availability statement

Deidentified and concatenated data can be available from the corresponding author on request.

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  • Contributors CP-A and MAC supervised the development of the registry core data elements and protocol and all authors participated; NC, SC and AT supervised data collection in their respective countries; CP-A, MAC and CJH developed study question and identified analytic approach; AZ conducted data analysis; CP-A drafted the manuscript; all authors contributed to data interpretation and critical review of the article.

  • Funding This work was funded by the NIH-Fogarty International Center project iCREATE: Increasing Capacity for Research in Eastern Europe (National Institutes of Health, Fogarty International Center 2D43TW007261, Peek-Asa and Dulf, Co-PIs) and NIH-National Institute for Neurological Disease and Stroke project INITIATE: International Collaboration to Increase Traumatic Brain Injury in Europe (5R21NS098850, Peek-Asa and Dulf, Co-PIs).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.