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Published on: August 16, 2019
Epidemiology of Global Pediatric Traumatic Brain Injury: Qualitative Review
Michael C Dewan1, Nishit Mummareddy1, John C Wellons1
1Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Insights
Traumatic brain injury (TBI) affects children globally, with incidence varying by country. Most pediatric TBI cases are mild and result in good outcomes, though nonaccidental trauma remains a concern worldwide.
Area of Science:
- Global Health
- Pediatric Epidemiology
- Traumatology
Background:
- Traumatic brain injury (TBI) is a significant global public health issue in children.
- Geopolitical, societal, and ethnic factors influencing pediatric TBI remain unclear.
Purpose of the Study:
- To investigate the global epidemiology of pediatric TBI.
- To compare TBI incidence, severity, and mechanisms across diverse geographic regions.
Main Methods:
- A systematic literature review of pediatric TBI studies published between 1995 and 2015.
- Data extraction included incidence, age, severity, and injury mechanisms from over 165,000 children across five continents.
Main Results:
- Worldwide pediatric TBI incidence ranges from 47 to 280 per 100,000 children, with significant country-specific variations.
- Mild TBI (Glasgow Coma Scale ≥13) accounts for over 80% of injuries; falls and motor vehicle collisions are primary causes.
- Nonaccidental trauma is prevalent globally; most children achieve good outcomes, but U.S. hospital admission rates are higher.
Conclusions:
- Pediatric TBI is a widespread condition transcending geographic and demographic boundaries.
- Improvements in civil infrastructure and public health policies are crucial for reducing the global burden of pediatric TBI.
Background:
Traumatic brain injury (TBI) is a common condition affecting children all over the world, and it represents a global public health concern. It is unclear how geopolitical, societal, and ethnic differences may influence the nature of TBI among children.
Methods:
A comprehensive literature search was conducted incorporating studies with hospital-, regional-, or country-specific pediatric TBI epidemiology data published between 1995 and 2015. Incidence, age, severity, mechanism of injury, and other relevant injury characteristics were extracted and compared across diverse geographic regions.
Results:
Thirty articles met inclusion criteria, incorporating TBI data from more than 165,000 children on 5 continents. The worldwide incidence of pediatric TBI ranges broadly and varies greatly by country, with most reporting a range between 47 and 280 per 100,000 children. After the age of 3, male children suffered higher rates of TBI than females. A bimodal age distribution is often described, with very young children (0-2 years) and adolescents (15-18) more commonly injured. Mild TBI (Glasgow Coma Scale ≥13) constitutes more than 80% of injuries, and up to 90% of all injuries are associated with negative imaging. Only a small fraction (<10%) requires surgical intervention. Independent of country or region of origin, the vast majority of children suffering TBI achieve a good clinical outcome. Hospital admission rates vary widely, with U.S. patients more commonly admitted than those from other countries. Falls and motor vehicle collisions (MVCs) represent the majority of injury mechanisms. In Africa and Asia, pedestrians were most commonly injured in MVCs, while vehicle occupants were more likely involved among Australian, European, and U.S.
Populations:
For children, nonaccidental trauma was prevalent in developing and developed nations alike.
Conclusions:
TBI is a relatively common entity stretching across traditional geographic and demographic boundaries and affecting pediatric populations worldwide. Continued civil infrastructure development and public health policy reforms may help to reduce the societal burden of pediatric TBI.
