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Published on: August 16, 2019
Clinical Characteristics and Outcomes of Pediatric Traumatic Brain Injury Patients in a Tertiary Regional Trauma
Maurice V Bayhon1,2, Ibet Marie Y Sih3,4
1Section of Neurosurgery, St. Luke's Medical Center and Dr. Paulino J. Garcia Memorial and Medical Research Center, Quezon City, Philippines.
Insights
Pediatric traumatic brain injury (TBI) in the Philippines is often caused by motor vehicle crashes, particularly in teenage males. While most cases are mild, severe TBI, especially epidural hematoma, requires attention and impacts outcomes.
Area of Science:
- Pediatric Traumatology
- Neuroscience
- Public Health
Background:
- Traumatic brain injury (TBI) is a significant cause of childhood disability and mortality globally.
- There is a scarcity of data on pediatric TBI in Southeast Asia, particularly in low- and middle-income countries.
- Understanding TBI in the Philippines is crucial for targeted interventions.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of pediatric TBI patients in a Philippine tertiary trauma center.
- To analyze injury mechanisms, TBI severity, and management strategies.
- To identify factors influencing patient outcomes and complications.
Main Methods:
- Retrospective cohort study of pediatric patients (≤18 years) admitted with TBI between 2021 and 2023.
- Data collection included demographics, injury mechanisms, TBI severity, imaging, surgical interventions, complications, and discharge status.
- Statistical analysis of collected data to determine trends and outcomes.
Main Results:
- 218 pediatric TBI patients were included; 75% were male, with a peak incidence in the 13-18 age group.
- Motor vehicle crashes were the primary injury mechanism (80% in older children).
- 69% of TBIs were mild; epidural hematoma was the most common finding (20%). Surgery was required in 8% of cases. Case fatality rate was 4.6%, with severe TBI having a 30.8% mortality rate.
Conclusions:
- Pediatric TBI in the Philippines is characterized by high-impact trauma, predominantly from motor vehicle crashes among adolescents.
- While most TBIs are mild, severe injuries and associated complications, including epidural hematoma, necessitate prompt surgical intervention.
- Findings underscore the need for enhanced road safety measures and further multi-center research to improve pediatric TBI outcomes.
Abstract:
Traumatic brain injury (TBI) is a leading cause of disability and death in children. Limited data exists on pediatric TBI in Southeast Asia, especially in low- and -middle-income countries. This study investigates the clinical characteristics and outcomes of pediatric TBI patients in a tertiary trauma center in the Philippines. This retrospective cohort study examined pediatric patients (18 years and under) with TBI admitted to a Philippine trauma center from 2021 to 2023. A total of 218 patients were included. Data on demographics, injury mechanisms, TBI severity, cranial imaging, surgical procedures, complications, and discharge outcomes were analyzed.
Abstract:
Among the 218 patients, 75% were male, and most were aged 13-18. The primary mechanism of injury was motor vehicle crashes (MVCs), especially in older children (80%). For patients under 5, falls and MVCs were equally common. Most cases were mild (69%), and 40.8% had negative cranial imaging. Epidural hematoma (20%) was the most common abnormal finding. Of the patients, 8% required surgery, with craniotomy for epidural hematoma being the most frequent procedure. Half of those who underwent surgery had neurological deficits, and there was one recorded death. Overall, 86.7% of patients were discharged without complications, though only 34.6% of those with severe TBI had good outcomes. The overall complication rate was 8.7%, with mild neurological deficits being most common. The case fatality rate was 4.6%, with severe TBI showing a higher rate of 30.8%. The majority of patients were male teenagers involved in MVCs. Although most TBIs were mild, there was a notable incidence of severe TBI, particularly with epidural hematoma. These findings suggest higher-impact trauma in the Philippines. The complication and mortality rates align with other studies. Efforts should focus on road safety, traffic law enforcement, and public education. A multi-center prospective study is needed to better understand the factors influencing outcomes in pediatric TBI.
