Characteristics and Outcome of Paediatric Traumatic Brain Injuries: An Analysis of 163 Patients in Enugu

Abstract

Background: As with most ailments common to adult and paediatric age groups, studies that describe and characterize paediatric traumatic brain injuries (TBIs) lag those of their adult counterparts. This is more so in the developing countries where national data are not well developed. The development of local clinical  guidelines has been shown to positively impact outcomes of paediatric TBI. Data on the characteristics and outcomes of TBI among paediatric age groups will provide a framework for the development of an  all‑encompassing management guideline.

Methods: In this study, a retrospective review of demography, mechanism of injury, pattern of presentation, nature of treatment, duration of hospital admission, and outcome of children aged 0–17 years managed for traumatic TBI at the University of Nigeria Teaching Hospital, Enugu‑Nigeria was performed. Data were analyzed using SPSS version 21. Relevant test statistics were used to test for associations. AP = 0.05 was considered  statistically significant.

Results: Atotal of 163 patients’ medical records were retrieved and analyzed. Of these, 117 (71.8%) were males and 46 (28.2%) were females. Their ages ranged from 6 weeks to 17 years with a mean age of 7.66 ± 5.1 years and peaked at 3–5 years. No difference in mean age between gender (P = 0.427). Pedestrian motor vehicular accident was the most common cause of injury. Fall from fruit trees and assault were peculiar to children from suburban/rural areas. TBI severity on admission was mild (44.2%), moderate (38.7%), and severe (17.2%). Other systemic injuries were present in 33.7%, of which long bone fractures were the most common (23/55). Abnormal brain computed tomography findings were seen in 83.2% with skull fracture being the most common finding. Operative procedures were carried out on 19.6% of patients. Conservative measures were the mainstay of management. The mean  duration of hospital admission was 14.01 ± 11.8 days was significantly associated with admission Glasgow Coma Scale (GCS) Score (P < 0.0001) and Glasgow Outcome Score (GOS) at discharge (P = 0.03). The overall outcome was good (GOS 4 and 5) in 92.0% and has a significant association with GCS on admission (P < 0.0001). Long‑term (Extended GOS) was 8 in 98.2% of those followed up.

Conclusion: Paediatric TBI is mainly mild to moderate in severity with a male predilection. The main cause is road traffic accidents with most victims being pedestrians. Management is mainly non-operative and the outcome at discharge is good even in a middle‑income country and significantly determined by GCS on admission.