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Clinical Epidemiology of Extracranial Injuries in Severe Pediatric Traumatic Brain Injury in South America
Miguel Castro1, Lauren L Agoubi2, Julia Velonjara3
1Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA; Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA.
Insights
Extracranial injuries are common in severe pediatric traumatic brain injuries (TBI) in South America. Serious extracranial injuries, often from road traffic injuries, are linked to longer hospital stays.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Global Health
Background:
- Severe traumatic brain injury (TBI) significantly impacts pediatric mortality, especially in low- and middle-income countries.
- The influence of accompanying extracranial injuries (ECI) on severe pediatric TBI outcomes is not well understood.
- This study provides the first epidemiological characterization of severe pediatric TBI with ECI in South America.
Purpose of the Study:
- To investigate the epidemiology and clinical course of severe pediatric TBI with concomitant extracranial injuries.
- To analyze the impact of different severities of ECI on patient outcomes.
- To identify injury mechanisms associated with TBI and ECI in the South American pediatric population.
Main Methods:
- Secondary analysis of baseline data from a TBI care clinical trial in Argentina, Paraguay, and Chile (Sept 2019-July 2020).
- Inclusion criteria: pediatric patients (≤18 years) with CT-confirmed TBI and Glasgow Coma Scale (GCS) score ≤8.
- Stratification by Abbreviated Injury Scale (AIS) for non-head injuries: isolated TBI (AIS=0), minor ECI (MEI; AIS=1-2), and serious ECI (SEI; AIS≥3). Comparison using ANOVA, t-tests, and chi-square tests.
Main Results:
- Of 116 children, 33% had isolated TBI, 34% MEI, and 34% SEI. Common ECIs included facial, thoracic, and abdominal injuries.
- Patients with SEI experienced longer hospital length of stay (LOS) compared to isolated TBI (median 28.0 vs 11.9 days).
- Road traffic injuries (RTIs) and falls were the most frequent mechanisms. RTI-associated TBI patients were older, more likely to have ECI, and had longer ICU and hospital LOS.
Conclusions:
- Extracranial injuries are prevalent in South American pediatric severe TBI cases.
- Serious ECI, particularly associated with RTIs, correlates with increased surgical procedures and prolonged hospital LOS.
- Enhanced strategies are required for the prevention and treatment of severe pediatric TBI within the South American context.
Background:
Severe traumatic brain injury (TBI) is a leading cause of pediatric mortality, with a disproportionate burden on low- and middle-income countries. The impact of concomitant extracranial injury (ECI) on these patients remains unclear. This study is the first to characterize the epidemiology and clinical course of severe pediatric TBI with extracranial injuries in any South American country.
Methods:
We conducted a secondary analysis of baseline data collected prior to implementation of a clinical trial on TBI care in Argentina, Paraguay, and Chile from September 2019 to July 2020. Patients ≤18 years with CT evidence of TBI, and a Glasgow coma scale (GCS) score ≤8 were recruited. Patients were initially stratified by highest non-head abbreviated injury scale (AIS): isolated TBI (AIS=0), minor extracranial injury (MEI; AIS=1-2), and serious extracranial injury (SEI; AIS≥3). Patients were subsequently stratified by mechanism of injury. Intergroup differences were compared using ANOVA, two-tailed unpaired t-tests, and chi-square tests.
Results:
Among the 116 children included, 33 % (n = 38) had an isolated TBI, 34 % (n = 39) had MEI, and 34 % (n = 39) had SEI. Facial (n = 53), thoracic (n = 44), and abdominal (n = 31) injuries were the most common ECIs. At discharge, there were no significant differences in median GCS, GOS, or GOS-extended between groups. Patients with SEI had a longer hospital LOS than those with isolated TBI (median 28.0 (IQR 10.6-40.1) vs 11.9 (IQR 8.7-20.7) days, p = 0.013). The most common mechanisms of injury were road traffic injuries (RTIs) (n = 50, 43 %) and falls (n = 35, 30 %). Patients with RTI-associated TBIs were more likely to be older (median 11.0 (IQR 3.0-14.0) vs 2.0 (IQR 0.8-7.0) years, p<0.001) and more likely to have an ECI (86% vs 54 %, respectively; p = 0.003). ICU and Hospital LOS for RTI patients (median 10.5 (IQR 6.1-21.1) and 24.1 (IQR 11.5-40.4) days) were longer than those of fall patients (median 6.1 (IQR 2.6-8.9) and 13.7 (IQR 7.7-24.5) days).
Conclusions:
Extracranial injuries are common in South American patients with severe TBI. Severe ECI is more frequently associated with RTIs and can result in a higher rate of surgical procedures and LOS. Further strategies are needed to characterize the prevention and treatment of severe pediatric TBI in the South American context.
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