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Predictors of In-Hospital Mortality for Road Traffic Accident-Related Severe Traumatic Brain Injury
Chien-Hung Chen1, Yu-Wei Hsieh2,3, Jen-Fu Huang4
1Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33305, Taiwan.
Insights
Road traffic accidents (RTAs) are a major cause of pediatric traumatic brain injury (TBI). Lower motor GCS scores and higher Rotterdam CT scores independently predict in-hospital mortality in severe pediatric TBI cases.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Emergency Medicine
Background:
- Road traffic accidents (RTAs) are the primary cause of pediatric traumatic brain injury (TBI), a condition linked to significant mortality.
- Research specifically addressing RTA-related pediatric TBI and its predictors remains limited.
Purpose of the Study:
- To investigate the clinical characteristics of children experiencing TBI due to RTAs.
- To identify early indicators of in-hospital mortality in pediatric patients with severe TBI resulting from RTAs.
Main Methods:
- A 15-year observational cohort study involving 618 children with RTA-related TBI.
- Data collected included demographics, road user type, Glasgow Coma Scale motor score (mGCS), vital signs, blood glucose, prothrombin time, and Rotterdam CT scores.
Main Results:
- Severe RTA-related TBI occurred in older children and was associated with a higher mortality rate (15.6%).
- In-hospital mortality was linked to hypothermia, lower mGCS, prolonged prothrombin time, hyperglycemia, and higher Rotterdam CT scores.
- Multivariate analysis identified mGCS and Rotterdam CT scores as independent predictors of mortality.
Conclusions:
- Pediatric TBI from RTAs carries a substantial in-hospital mortality risk.
- Initial clinical indicators such as hypothermia, low mGCS, prolonged prothrombin time, hyperglycemia, and elevated Rotterdam CT scores are associated with mortality.
- The mGCS and Rotterdam CT scores serve as independent predictors for in-hospital mortality in this population.
Abstract:
(1) Background: Road traffic accidents (RTAs) are the leading cause of pediatric traumatic brain injury (TBI) and are associated with high mortality. Few studies have focused on RTA-related pediatric TBI. We conducted this study to analyze the clinical characteristics of RTA-related TBI in children and to identify early predictors of in-hospital mortality in children with severe TBI. (2) Methods: In this 15-year observational cohort study, a total of 618 children with RTA-related TBI were enrolled. We collected the patients' clinical characteristics at the initial presentations in the emergency department (ED), including gender, age, types of road user, the motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and the intracranial computed tomography (CT) Rotterdam score, as potential mortality predictors. (3) Results: Compared with children exhibiting mild/moderate RTA-related TBI, those with severe RTA-related TBI were older and had a higher mortality rate (p < 0.001). The in-hospital mortality rate for severe RTA-related TBI children was 15.6%. Compared to children who survived, those who died in hospital had a higher incidence of presenting with hypothermia (p = 0.011), a lower mGCS score (p < 0.001), a longer initial prothrombin time (p < 0.013), hyperglycemia (p = 0.017), and a higher Rotterdam CT score (p < 0.001). Multivariate analyses showed that the mGCS score (adjusted odds ratio (OR): 2.00, 95% CI: 1.28-3.14, p = 0.002) and the Rotterdam CT score (adjusted OR: 2.58, 95% CI: 1.31-5.06, p = 0.006) were independent predictors of in-hospital mortality. (4) Conclusions: Children with RTA-related severe TBI had a high mortality rate. Patients who initially presented with hypothermia, a lower mGCS score, a prolonged prothrombin time, hyperglycemia, and a higher Rotterdam CT score in brain CT analyses were associated with in-hospital mortality. The mGCS and the Rotterdam CT scores were predictive of in-hospital mortality independently.
