Pediatric traumatic brain injury and later psychotic syndromes in Finland

The association between pediatric traumatic brain injury (pTBI) and post-traumatic psychotic syndromes remains understudied subject. The objective of this study was to evaluate the association between pTBI and subsequent psychotic syndrome incidence in Finland. A nationwide retrospective cohort study in Finland from 1998 to 2018 included 71,969 pediatric (< 18 years) TBI patients and 64,856 references with distal extremity fractures. Our primary outcome was psychotic syndrome occurrence post-pTBI, analyzed via Kaplan-Meier (KM) survival and multivariable Cox regression with 95% confidence intervals (CI).. KM analyses demonstrated consistently elevated rates in pediatric TBI (pTBI), particularly notable 10 years post-trauma. Beyond the initial year, cumulative incidence was 0.04% in pTBI and 0.02% in the reference group. Cox regression revealed increased long-term psychotic syndrome risk in pTBI compared to the reference. Up to 10 years of follow-up, the hazard ratio (HR) was 1.34 (95% CI: 1.16-1.55). Notably, among females, pTBI exhibited higher cumulative rates than the reference group. Post the first year, cumulative incidence was 0.06% (pTBI) versus 0.03% (reference) for females. Following 3 years, the HR for pTBI females was 2.00 (95% CI: 1.24-3.23), decreasing to 1.08 (95% CI: 0.90-1.30) from 3 to 20 years.

These findings suggest that the risk of psychotic syndromes remains slightly elevated up to 10 years following pTBI.

• The association between pTBI and post-traumatic psychotic syndromes is relatively understudied. Existing literature mainly focuses on schizophrenia.

• This nationwide study found an association between pTBI and an increased risk of post-traumatic psychotic syndromes, particularly within the first 10 years after injury. Notably, female patients faced a higher risk.