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Published on: August 16, 2019
Traumatic Brain Injury-Related Pediatric Mortality and Morbidity in Low- and Middle-Income Countries: A Systematic
Soham Bandyopadhyay1, Michal Kawka2, Katya Marks3
1Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.
Insights
Pediatric traumatic brain injuries (pTBI) are a significant concern in low- and middle-income countries (LMICs), with road traffic accidents being a primary cause. Young males face a higher risk of pTBI, often resulting in lasting functional impairments.
Area of Science:
- Global Health
- Pediatric Neurology
- Public Health
Background:
- The global burden of pediatric traumatic brain injury (pTBI) in low- and middle-income countries (LMICs) remains largely unquantified.
- Existing data on pTBI in LMICs is scarce and often of low quality.
Purpose of the Study:
- To characterize the causes of pTBI in LMICs.
- To determine the associated mortality and morbidity of pTBI in LMICs.
Main Methods:
- A systematic review of observational and experimental studies on pTBI in individuals aged 0-16 years in LMICs was conducted.
- Studies were identified through searches of MEDLINE, Embase, Global Health, and Global Index Medicus from January 2000 to May 2020.
- Causes of pTBI, morbidity, and case fatality rates were descriptively analyzed.
Main Results:
- A total of 136 studies were included, with 170,224 cases of pTBI reported across 32 LMICs.
- Males had 1.8 times higher odds of experiencing pTBI. Road traffic accidents were the most frequent cause (39%).
- 24% of patients experienced a reduction in mental or physical function post-discharge, with a median case fatality rate of 7.3%.
Conclusions:
- High-quality data on pTBI burden in LMICs is lacking, with less than a quarter of LMICs publishing such research.
- Young males are identified as a high-risk group for pTBI in LMICs.
- Road traffic accidents are a major contributor to pTBI in this population, highlighting the need for targeted prevention strategies.
Background:
The burden of pediatric traumatic brain injury (pTBI) in low- and middle-income countries (LMICs) is unknown. To fill this gap, we conducted a review that aimed to characterize the causes of pTBI in LMICs, and their reported associated mortality and morbidity.
Methods:
A systematic review was conducted. MEDLINE, Embase, Global Health, and Global Index Medicus were searched from January 2000 to May 2020. Observational or experimental studies on pTBI of individuals aged between 0 and 16 years in LMICs were included. The causes of pTBI and morbidity data were descriptively analyzed, and case fatality rates were calculated.
Prospero Id:
CRD42020171276.
Results:
A total of 136 studies were included. Fifty-seven studies were at high risk of bias. Of the remaining studies, 170,224 cases of pTBI were reported in 32 LMICs. The odds of having a pTBI were 1.8 times higher (95% confidence interval, 1.6-2.0) in males. The odds of a pTBI being mild were 4.4 times higher (95% confidence interval, 1.9-6.8) than a pTBI being moderate or severe. Road traffic accidents were the most common cause (n = 16,275/41,979; 39%) of pTBIs. On discharge, 24% of patients (n = 4385/17,930) had a reduction in their normal mental or physical function. The median case fatality rate was 7.3 (interquartile range, 2.1-7.7).
Conclusions:
Less than a quarter (n = 32) of all LMICs have published high-quality data on the volume and burden of pTBI. From the limited data available, young male children are at a high risk of pTBIs in LMICs, particularly after road traffic accidents.
