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Published on: August 16, 2019
Global Epidemiology of Pediatric Traumatic Brain Injury: Systematic Review and Meta-Analysis
Ronnie E Baticulon1, Jinno Jenkin Sy2, Joseline Haizel-Cobbina3,4
1Department of Neurosciences, Division of Neurosurgery, Philippine General Hospital, University of the Philippines Manila, Manila , Philippines.
Insights
Global pediatric traumatic brain injury (TBI) affects 226.4 per 100,000 children annually, with significant disparities in incidence and outcomes across countries. Further research is needed, especially in low-income nations.
Area of Science:
- Global Health
- Pediatric Neurology
- Epidemiology
Background:
- Traumatic brain injury (TBI) is a major cause of death and disability in children globally.
- Understanding the worldwide incidence and outcomes of pediatric TBI is crucial for public health initiatives.
Purpose of the Study:
- To estimate the global incidence of pediatric TBI.
- To compare the clinical presentation and outcomes of pediatric TBI across different countries, regions, and income settings.
Main Methods:
- Systematic review of studies on pediatric TBI published from 2000 onwards.
- Meta-analyses of population-level data to calculate TBI incidence and mortality.
- Pooling of hospital-level data to determine mortality rates, severity, and causes of TBI.
Main Results:
- Estimated global incidence of pediatric TBI is 226.4 per 100,000 children annually.
- Annual TBI-related mortality is estimated at 1.9 per 100,000 children.
- 11.0% of pediatric TBI cases are severe, with higher incidence and mortality in low- and middle-income countries.
- Road traffic injuries are a primary cause in Africa and low-income countries, while falls are more common elsewhere.
Conclusions:
- Approximately 5.4 million children worldwide experience TBI each year.
- Observed disparities in TBI incidence may reflect true variations or differences in healthcare system capacity.
- A significant lack of population-level data exists for low- and lower-middle-income countries regarding pediatric TBI.
Background And Objectives:
Traumatic brain injury (TBI) is a public health concern that leads to premature deaths and disability in a large number of children worldwide. The aim of this study was to estimate the global incidence of pediatric TBI and to compare the clinical presentation and outcome of pediatric TBI in different countries, regions, and income settings.
Methods:
A systematic review was conducted to identify studies on pediatric patients with TBI published from 2000 onward. Studies that contained population-level data were included in meta-analyses to calculate the incidence of TBI and TBI-related mortality. Studies that reported hospital-level data were pooled to calculate mortality rates, proportion of patients with severe TBI, and proportion of TBI resulting from falls and road traffic injuries.
Results:
The estimated global incidence of pediatric TBI was 226.4 per 100 000 children annually, using data from 25 studies in 5 regions. An estimated 1.9 per 100 000 children die from TBI each year. Based on 79 studies from 42 countries, 11.0% (median: 10.7%) of patients had severe TBI. The overall mortality rate was 1.4% (median: 3.2%). In 28 studies, the median mortality rate for severe TBI was 26.7%. Studies from low-income and middle-income countries reported higher proportions of patients with severe TBI and higher mortality rates. Road traffic injuries were the most common cause of TBI among children in Africa and in low-income countries. Falls were more common in other regions.
Conclusion:
Every year, about 5.4 million children worldwide sustain a TBI. Disparities in the estimated incidence rates of pediatric TBI among countries may represent true differences in frequency or variability in the capacity of health systems to address TBI. Population-level data remain lacking in low-income and lower-middle-income countries.
