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Survival and Functional Outcomes at Discharge After Traumatic Brain Injury in Children versus Adults in Resource-Poor
Laura N Purcell1, Rachel Reiss2, Jessica Eaton3
1Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
Insights
Children with traumatic brain injury (TBI) show better survival and functional outcomes compared to adults. This study in Malawi suggests potential increased resiliency in pediatric patients or resource prioritization, highlighting the need for neurosurgical care investments.
Area of Science:
- Neuroscience
- Trauma Surgery
- Global Health
Background:
- Trauma mortality is disproportionately high in low- and middle-income countries, particularly in sub-Saharan Africa.
- Head injuries represent a leading cause of trauma-related deaths in both prehospital and in-hospital settings.
Purpose of the Study:
- To compare outcomes in pediatric versus adult patients with traumatic brain injury (TBI).
- To identify factors associated with favorable functional outcomes and mortality in TBI patients in a resource-limited setting.
Main Methods:
- An observational study was conducted at Kamuzu Central Hospital, Malawi, from October 2016 to May 2017.
- Data from 356 TBI patients were analyzed using bivariate and logistic regression to determine odds of favorable outcomes and mortality.
Main Results:
- Motor vehicle crashes were the primary cause of TBI in both adult and pediatric cohorts.
- Pediatric patients (18.1%) had lower mortality rates compared to adults (32.3%).
- Children demonstrated a significantly higher likelihood of favorable functional outcomes (good recovery or moderate disability) and reduced mortality on multivariable analysis.
Conclusions:
- Pediatric patients exhibit a survival advantage and better functional recovery after TBI compared to adults.
- This observed benefit may stem from enhanced pediatric resilience to TBI or preferential resource allocation in resource-poor environments.
- Increased investment in neurosurgical care is crucial for improving TBI patient outcomes globally.
Background:
More than 90% of trauma mortality occurs in low- and middle-income countries, especially in sub-Saharan Africa. Head injury is the primary driver of trauma mortality in the prehospital and in-hospital setting.
Methods:
An observational study was performed on patients presenting with traumatic brain injury (TBI) from October 2016 through May 2017 at Kamuzu Central Hospital, Malawi. Bivariate analysis and logistic regression were performed to determine the odds of favorable functional outcomes and mortality after controlling for significant covariates.
Results:
Of the 356 patients with TBI, 72 (20.2%) were children <18 years of age. Males comprised 202 (87.1%) and 46 (63.9%) of the adult and pediatric cohorts, respectively. Motor vehicle crash was the leading etiology in adults and children. There was no significant difference between adult and pediatric Glasgow Coma Scale score on admission, 10.8 ± 3.9 versus 10.9 ± 3.5, respectively (P = 0.8). More adult (n = 76, 32.3%) than pediatric (n = 13, 18.1%) patients died. On multivariable analysis, pediatric patients were more likely to have a favorable outcome defined by a Glasgow Outcome Scale of good recovery or moderate disability (odds ratio 3.70, 95% confidence interval 1.22-11.17, P = 0.02) and were less likely to die after TBI (odds ratio 0.29, 95% confidence interval 0.09-0.93, P = 0.04).
Conclusions:
We show a survival advantage and better functional outcomes in children following TBI. This may be attributable to increased resiliency to TBI in children or the prioritization of children in a resource-poor environment. Investments in neurosurgical care following TBI are needed to improve outcomes.
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