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Updated: Jun 21, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Preclinical care of children with traumatic brain injury (TBI)
Peter Sefrin1, Michael Brandt, Markus Kredel
1Klinik und Poliklinik für Anästhesiologie, Sektion für Präklinische Notfallmedizin, University of Würzburg, Germany. Sefrin_P@klinik.uni-wuerzburg.de
Insights
Accidents are a leading cause of death in young people, with traumatic brain injuries (TBIs) being common in traffic incidents. Further training for emergency physicians is needed to improve TBI care in children.
Area of Science:
- Pediatrics
- Traumatology
- Emergency Medicine
Background:
- Accidental injuries are a primary cause of mortality in children and adolescents in Germany.
- Traffic accidents represent a significant portion of these injuries, necessitating focused research.
Purpose of the Study:
- To analyze the incidence and characteristics of traumatic brain injuries (TBIs) in children and adolescents involved in traffic accidents.
- To evaluate the clinical presentation, emergency medical response, and outcomes for pediatric TBI patients.
Main Methods:
- Analysis of 200,221 emergency service records from Bavaria (1995-1999).
- Focus on 721 pediatric patients (age group) with traffic-related injuries, specifically identifying those with TBI.
- Assessment using Glasgow Coma Scale (GCS) and National Advisory Committee for Aeronautics (NACA) scores.
Main Results:
- Traumatic brain injury (TBI) was identified in 45.8% of traffic injuries among children and adolescents.
- Peak incidence of TBI occurred during summer and in the early evening (4-6 PM).
- Older children (7-14 years) and boys were more susceptible; most patients had mild neurological deficits (GCS 15).
- Circulatory parameters showed abnormalities in a minority of cases; interventions included IV lines, oxygenation, and analgesics.
- Discrepancies between NACA and GCS scores were noted, suggesting potential challenges in assessment.
Conclusions:
- Pediatric TBI symptoms can be less apparent than in adults, potentially restricting timely therapeutic measures.
- Age-dependent differences in TBI presentation necessitate specialized training for emergency physicians.
- Enhanced training and education are crucial for improving preclinical management of pediatric TBI.
Abstract:
The fact that injuries caused by accidents are the most common cause of death in children and adolescents in Germany gave rise to the study, which mainly deals with traffic accidents in this group. 200,221 records of emergency-service physicians in Bavaria which cover the period 1995-1999 were analysed with respect to the importance of traumatic brain injury (TBI) in children and adolescents (n = 721 - representing 45.8% of traffic injuries in this age group). The highest incidence of TBI was in summer (34.3%) and in the evening between 16.00 and 18.00 (23.7%). The time taken between accident and arrival of the emergency services was 8.8 +/- 3.1 minutes. The preclinical phase lasted 19.3 +/- 5.8 minutes. The probability of having an accident with TBI increases with age, the maximum being in the age-range 7 - 14 years (61.6%). Boys (63.2%) were almost twice as susceptible to injury as girls. 36.8% of all cases had no noticeable neurological disorder, 71.1% resulted in a Glasgow Coma Scale (GCS) score of 15. Only 6.3% had most severe neurological disorders, resulting in a GCS score of 3 - 5. Circulation parameters in the form of adapted hypotension were abnormal in only 3.4%, 21.9% of the children had a bradycardia and in 12.3% the blood oxygen saturation fell below 94%. The most frequent intervention was the laying of an i.v. line for infusions. 8.6% of the patients were intubated to allow for ventilation with oxygen. Analgesics were given in 16.7% of the cases. In 84.7% of all cases, the condition was stable and in only 3.3% was a severe deterioration to be observed. The assessments were made using both the National Advisory Committee for Aeronautics (NACA) and Glasgow Coma Scales (GCS). Discrepancies occurred, as a NACA scale of I - III and a GCS score of < 9 was reported in 4.9% of cases. In contrast a NACA scale of IV - VI was reported with a GCS score of 15 in 30% of all cases. TBI symptoms in children are less obvious than in adults, which leads to an age-dependent restriction in implementing therapeutic measures. If these restrictions are a result of misinterpretation of the situation or due to a lack of practice in the preclinical phase, then further training and education of the physicians involved in emergency service work are necessary.
