Serious Concomitant Injuries in Pediatric Patients with Severe Traumatic Brain Injury

Severe traumatic brain injury (TBI) is a leading cause of death among children. Although several studies have reported the negative effects of concomitant injuries on mortality in adults with TBI, their effect on pediatric patients remains unclear. Our objective was to describe the effect of serious concomitant injuries on outcomes in pediatric patients with severe TBI.

We identified pediatric patients (<18 years) with severe TBI between 2004 and 2015, through the Japan Trauma Data Bank. We excluded patients who had cardiopulmonary arrest on arrival and those whose main outcome (mortality) was missed from the analyses. Two groups with severe TBI were compared on the basis of the presence of serious concomitant injuries (maximum Abbreviated Injury Scale score ≥3 in regions other than the head) and adjusted for potential confounders using multiple logistic regression analysis.

One-thousand-and-thirty-four participants were eligible for analysis, of which 472 had serious concomitant injuries. Pediatric patients with a serious concomitant injury had higher mortality. The probability difference was 11.5 (95% confidence interval [CI]: 6.1%-16.9%), which was greater than the mortality of 1.5 (95% CI: 1.2%-1.8%) observed in patients with a serious injury but not TBI. The presence of a serious concomitant injury was significantly associated with increased mortality, even after adjusting for possible confounders (adjusted odds ratio, 2.01; 95% CI, 1.40-2.89; P < 0.001).

Serious concomitant injuries are associated with higher mortality in pediatric patients with severe TBI, as a direct consequence, as well as due to concomitant injuries potentiating TBI pathobiology.