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Updated: Jul 13, 2026
Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
Published on: August 16, 2019
Differences in clinical outcomes and resource utilization in pediatric traumatic brain injury between countries of
Keith Wei Han Liang1,2, Jan Hau Lee2,3, Syeda K Qadri2,3
1Departments of1Pediatric Medicine and.
Insights
Children with traumatic brain injuries (TBIs) in low- and middle-income countries (LMICs) face worse functional outcomes and increased resource use. Targeted interventions are needed to address these disparities in pediatric TBI care.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Global health disparities
Background:
- Traumatic brain injury (TBI) presents a significant global health challenge, with a disproportionately high burden in low- and middle-income countries (LMICs).
- Understanding regional differences in clinical outcomes and healthcare resource utilization for pediatric TBI is crucial for developing effective interventions.
Purpose of the Study:
- To compare clinical outcomes and healthcare utilization for children with moderate to severe TBIs between LMICs and non-LMICs in Asia and Latin America.
- To identify factors associated with poor functional outcomes in pediatric TBI patients across different economic settings.
Main Methods:
- An observational, multicenter study was conducted from January 2014 to February 2023, involving pediatric intensive care units (PICUs) in Asia and Latin America.
- Sites were classified as LMICs or non-LMICs based on the 2019 sociodemographic index (SDI).
- Clinical outcomes, including mortality, functional status (Pediatric Cerebral Performance Category - PCPC), and PICU/hospital-free days, were compared. Multivariable logistic regression was used to predict poor functional outcomes.
Main Results:
- While mortality rates were similar, children with TBI in LMICs experienced significantly poorer functional outcomes (higher PCPC scores) and fewer ICU/hospital-free days compared to those in non-LMICs.
- LMIC status, lower Glasgow Coma Scale scores, and multiple trauma were independently associated with poor functional outcomes.
- Children in LMICs demonstrated greater resource utilization, including earlier intubation, mechanical ventilation, hyperosmolar therapy, and antiepileptic drug use.
Conclusions:
- Children with moderate to severe TBIs in LMICs within Asia and Latin America face a higher likelihood of poor functional outcomes and require more intensive resource utilization.
- These findings highlight significant disparities in pediatric TBI care between LMICs and non-LMICs.
- Further research is warranted to investigate the underlying causes of these disparities and to develop targeted interventions to improve outcomes for children with TBI in resource-limited settings.
Objective:
The burden of traumatic brain injury (TBI) is disproportionately high in low- and middle-income countries (LMICs). This study aimed to compare clinical outcomes and healthcare utilization for children with moderate to severe TBIs between LMICs and non-LMICs in Asia and Latin America.
Methods:
The authors performed an observational multicenter study from January 2014 to February 2023 among children with moderate to severe TBIs admitted to participating pediatric intensive care units (PICUs) in the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) and Red Colaborativa Pediátrica de Latinoamérica (LARed Network). They classified sites according to their 2019 sociodemographic index (SDI). Low, low-middle, and middle SDI sites were considered LMICs, while high-middle and high SDI sites were considered non-LMICs. The authors documented patient demographics and TBI management. Accounting for death, they recorded 14-day PICU-free and 28-day hospital-free days, with fewer free days indicating poorer outcome. The authors compared children who died and those who had poor functional outcomes (defined as Pediatric Cerebral Performance Category [PCPC] level of moderate disability, severe disability, or vegetative state or coma) between LMICs and non-LMICs and performed a multivariable logistic regression analysis for predicting poor functional outcomes.
Results:
In total, 771 children with TBIs were analyzed. Mortality was comparable between LMICs and non-LMICs (9.6% vs 12.9%, p = 0.146). Children with TBIs from LMICs were more likely to have a poor PCPC outcome (31.0% vs 21.3%, p = 0.004) and had fewer ICU-free days (median [IQR] 6 [0-10] days vs 8 [0-11] days, p = 0.004) and hospital-free days (median [IQR] 9 [0-18] days vs 13 [0-20] days, p = 0.007). Poor functional outcomes were associated with LMIC status (adjusted OR [aOR] 1.53, 95% CI 1.04-2.26), a lower Glasgow Coma Scale score (aOR 0.83, 95% CI 0.78-0.88), and the presence of multiple trauma (aOR 1.49, 95% CI 1.01-2.19). Children with TBIs in LMICs required greater resource utilization in the form of early intubation and mechanical ventilation (81.6% vs 73.2%, p = 0.006), use of hyperosmolar therapy (77.7% vs 63.6%, p < 0.001), and use of antiepileptic drugs (73.9% vs 53.1%, p < 0.001).
Conclusions:
Within Asia and Latin America, children with TBIs in LMICs were more likely to have poor functional outcomes and required greater resource utilization. Further research should focus on investigating causal factors and developing targeted interventions to mitigate these disparities.
