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Eka Burkadze,1 Ketevan Axobadze,1 Nino Chkhaberidze,1 Nino Chikhladze,1 Madalina Adina Coman,2 Diana Dulf,2 Corinne Peek-Asa3 1Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia; 2Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania; 3Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USACorrespondence: Eka BurkadzeDepartment of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, 1 Chavchavadze Ave, Tbilisi, 0179, GeorgiaTel +995 591 11 80 90Email eka.burkadze@tsu.gePurpose: Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality worldwide, disproportionally affecting low- and middle-income countries (LMICs). Epidemiological characteristics of TBI at a national level are absent for most LMICs including Georgia. This study aimed to establish the registries and assess causes and outcomes in TBI patients presenting to two major trauma hospitals in the capital city –Tbilisi.Patients and Methods: The prospective observational study was conducted at Acad. O. Gudushauri National Medical Center and M. Iashvili Children’s Central Hospital from March, 1 through August, 31, 2019. Patients of all age groups admitted to one of the study hospitals with a TBI diagnosis were eligible for participation. Collected data were uploaded using the electronic data collection tool –REDCap, analyzed through SPSS software and evaluated to provide detailed information on TBI-related variables and outcomes using descriptive statistics.Results: Overall, 542 hospitalized patients were enrolled during the study period, about 63% were male and the average age was 17.7. The main causes of TBI were falls (58%) and struck by or against an object (22%). The 97% suffered from mild TBI (GCS 13– 15). Over 23% of patients arrived at the hospital more than 1 hour after injury and 25% after more than 4-hours post-injury. Moderate and severe TBI were associated with an increased hospital length of stay. Mortality rate of severe TBI was 54%.Conclusion: This study provides important information on the major epidemiological characteristics of TBI in Georgia, which should be considered for setting priorities for injury management.Keywords: traumatic brain injury, injury epidemiology, registry, Georgia

Background The World Health Organization predicts a striking rise in the burden of traumatic brain injury (TBI) burden in the next decades. A disproportionately large increase is predicted in low- and middle-income countries, which have brain injury rates 3 times higher than high-income countries. The aim of this study was to identify current TBI practices and treatment capacity in 3 low- and middle-income countries: Republic of Armenia, Georgia, and Republic of Moldova. Methods After a national inventory of hospitals treating TBI, a situational analysis was conducted in the highest volume adult and pediatric hospital in each country. The situational analysis included key informant interviews with content analysis and a quantitative checklist of treatment resources. Results All 3 countries follow international, national, and hospital protocols for TBI treatment, and the in-hospital management of patients with TBI is similar to international standards in all 3 countries. Although health care specialists were well trained, however, lack of proper equipment, a scant number of hospitals outside the capital region, lack of specialized personnel in regional areas, and lack of rehabilitation services were mentioned as difficulties in interviews from all 3 countries. Conclusions Particular gaps were found in pre-hospital and rehabilitative care, as well as national leadership and data collection. Surveillance and standardized data collection are important measures to fill treatment gaps and reduce the burden of TBI.

Police crash reports are often the main source for official data in many countries. However, with the exception of fatal crashes, crashes are often underreported in a biased manner. Consequently, the countermeasures adopted according to them may be inefficient. In the case of bicycle crashes, this bias is most acute and it probably varies across countries, with some of them being more prone to reporting accidents to police than others. Assessing if this bias occurs and the size of it can be of great importance for evaluating the risks associated with bicycling.This study utilized data collected in the COST TU1101 action "Towards safer bicycling through optimization of bicycle helmets and usage". The data came from an online survey that included questions related to bicyclists´ attitudes, behaviour, cycling habits, accidents, and patterns of use of helmets. The survey was filled by 8655 bicyclists from 30 different countries. After applying various exclusion factors, 7015 questionnaires filled by adult cyclists from 17 countries, each with at least 100 valid responses, remained in our sample.The results showed that across all countries, an average of only 10% of all crashes were reported to the police, with a wide range among countries: from a minimum of 0.0% (Israel) and 2.6% (Croatia) to a maximum of a 35.0% (Germany). Some factors associated with the reporting levels were type of crash, type of vehicle involved, and injury severity. No relation was found between the likelihood of reporting and the cyclist´s gender, age, educational level, marital status, being a parent, use of helmet, and type of bicycle.The significant under-reporting - including injury crashes that do not lead to hospitalization - justifies the use of self-report survey data for assessment of bicycling crash patterns as they relate to (1) crash risk issues such as location, infrastructure, cyclists´ characteristics, and use of helmet and (2) strategic approaches to bicycle crash prevention and injury reduction. Fil: Shinar, D.. Ben Gurion University of the Negev; Israel Fil: Valero-Mora, P.. Universidad de Valencia; España Fil: van Strijp-Houtenbos, M.. Institute For Road Safety Research, Netherlands; Países Bajos Fil: Haworth, N.. Queensland University Of Technology Qut; Australia Fil: Schramm, A.. Queensland University Of Technology Qut; Australia Fil: de Bruyne, G.. Universiteit Antwerp; Bélgica Fil: Cavallo, V.. Ifsttar - French Institute Of Science And Technology For Transport, Development And Networks; Fil: Chliaoutakis, J.. Technologiko Ekpaideutiko Idrima, Kritis; Fil: Dias, J.. Instituto Superior Tecnico; Portugal Fil: Ferraro, O.E.. Universita Degli Studi Di Pavia; Fil: Fyhri, A.. Transportokonomisk Institutt; Fil: Sajatovic, A. Hursa. University Of Zagreb, Faculty Of Textile Technology; Fil: Kuklane, K.. Lund University; Suecia Fil: Ledesma, Ruben Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Mascarell, O.. Ben Gurion University of the Negev; Israel Fil: Morandi, A.. Universita Degli Studi Di Pavia; Fil: Muser, M.. Working Group On Accident Mechanics; Fil: Otte, D.. Medizinische Hochschule Hannover (mhh); Fil: Papadakaki, M.. Technologiko Ekpaideutiko Idrima, Kritis; Fil: Sanmartín, J.. Universidad de Valencia; España Fil: Dulf, D.. Universitatea Babes-bolyai Din Cluj-napoca; Fil: Saplioglu, M.. Suleyman Demirel Universitesi; Fil: Tzamalouka, G.. Technologiko Ekpaideutiko Idrima, Kritis