Brain injuries: health care capacity and policy in Georgia

Background: over 90% of morbidity and mortality associated with traumatic brain injury (tbi)occurs in low- and middle-income countries. lack of reliable, high-quality data regarding tbiprevention and care hinders the ability to reduce tbi burden. we sought to identify current tbidata collection practices and capacity in georgia, focusing on pre-hospital, hospital, andrehabilitation treatment.methods: the eight level i and two level ii trauma hospitals in georgia with the highest numberof tbi admissions in 2017 were selected for study. a semi-structured survey about various aspectsof tbi care was designed and semi-structured interviews of healthcare providers treating tbipatients (e.g. neurologists, neurosurgeons) were conducted based on this survey.results: pre-hospital triage protocols were not routinely used to match patient treatment needswith hospital capacity. all hospitals provided specialist care for tbi 24 hours/day. mri wasavailable at only three (30%) centers, and in-hospital rehabilitation units were available in only one (10%). no center used a defined protocol for treating tbi patients and no national protocolexists.conclusion: even among the largest, most highly specialized hospitals in georgia, tbi care variesin terms of diagnostic and treatment protocols. while tbi specialists are available, diagnosticequipment often is not. gaps in pre-hospital coordination and access to rehabilitation servicesexist and provide areas of focus for future investment in reducing tbi burden.