Abstract Traumatic Brain Injury (TBI), worldwide, is the leading cause of disability in people under age 40, with peak incidence at 15-24 years of age. The overwhelming majority of injuries that lead to death and disability come from moderate or severe brain injury. The burden of TBI is greatest in low- and middle-income countries (LAMIC), where 85% of the world's population lives. The rationale for the proposed project is that due to several common issues, in particular a lack of research infrastructure, in LAMICs (such as Ghana), there is very little reliable data about TBI or its impact in these settings. The limited preliminary TBI data available in Ghana provides minimal insight as to what extent the appropriate treatments for TBI are being delivered and suggests that inappropriate care for TBI patients could be substantial. This project, building on our novel emergency medicine program and department (ED), will determine the characteristics and outcomes of patients with moderate or severe TBI, as well as evaluate the acute care they received after presenting to two hospitals in the Ashanti Region of Ghana. The utilization of this LAMIC ED to gather prospective data about these patients, their care and outcomes (utilizing the Extended Glasgow Outcome Scale and TBI-Quality of Life Measures), using a web based electronic database displays innovation in our approach. Using a structured implicit review process, we will determine the frequency and nature of any suboptimal or inappropriate care that is being delivered to these patients. We then will analyze the relationship of suboptimal care to outcome, as well as other factors associated with functional outcomes. During this process, and through direct mentorship, two junior faculty members will gain experience in conducting TBI research and implement the electronic database at a second site. The long term goal is that the results will lead to new knowledge and testable hypotheses to improve care and outcomes of TBI patients that can be evaluated in future studies. This project will be an important step towards understanding TBI, its care and outcomes while increasing the capacity for further studies.

Narrative Research resources generated from this grant will include the enhanced trauma registry format. This resource, as appropriate, will be made freely available upon request from qualified investigators for non-commercial research. My institution and I will adhere to the NIH Grants Policy on Sharing of Unique Research Resources. Should any intellectual property arise which requires a patent, we would ensure that the technology remains widely available to the research community in accordance with the NIH Principles and Guidelines document.