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Pediatric Traumatic Brain Injury Patients in Southwestern Nigeria: Presentation Patterns and Outcome
Jennifer Okei1, Omotayo A Ojo1,2, OyinOluwa G Adaramola1
1Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria.
Insights
Pediatric traumatic brain injury (TBI) is uncommon but deadly in Nigerian children. Poverty and lack of insurance significantly worsened outcomes, with severe TBI cases showing higher mortality.
Area of Science:
- Pediatric neurology
- Trauma surgery
- Public health
Background:
- Traumatic brain injury (TBI) is a significant global cause of child mortality.
- Pediatric TBI presents unique challenges compared to adult TBI.
- Understanding TBI in low-resource settings is crucial for improving outcomes.
Purpose of the Study:
- To investigate the prevalence of pediatric TBI.
- To identify etiological factors and management strategies for pediatric TBI.
- To analyze the outcomes of pediatric TBI at a major Nigerian referral center.
Main Methods:
- Prospective study of pediatric TBI patients under 18.
- Data collection on demographics, injury mechanisms, management, and outcomes.
- Statistical analysis using IBM SPSS Statistics (v28).
Main Results:
- 26 pediatric TBI cases were analyzed, with a male predominance (1.6:1).
- Road traffic accidents (42.3%) were the leading cause, followed by falls (26.9%).
- Financial constraints limited CT scans (57.7%) and surgical interventions (50% of indicated cases), contributing to an 11.5% mortality rate, primarily in severe TBI.
Conclusions:
- Pediatric TBI has a low prevalence but a high mortality rate in this Nigerian cohort.
- Socioeconomic factors, including poverty and lack of health insurance, significantly impede access to timely and adequate care.
- Addressing financial barriers is critical for improving pediatric TBI outcomes.
Background:
Traumatic brain injury (TBI) is less common in children than in adults but is a leading cause of mortality in children globally. The study aimed to explore the prevalence, etiological factors, management, and outcomes of pediatric TBI at Lagos University Teaching Hospital (LUTH), a major referral center in Nigeria.
Materials And Methods:
This prospective study included children under 18 diagnosed with TBI from January 1 to December 31, 2022. Ethical clearance was obtained, and informed consent was collected from caregivers. Data were gathered using a pre-designed proforma covering socio-demographics, injury mechanisms, pre-hospital management, clinical findings, and outcomes. Analysis was performed using IBM SPSS Statistics(v28).
Results:
Twenty-six patients with a mean age of 9.0 ± 5.99 years with a male-to-female ratio of 1.6:1 were enrolled. Only two (7.7%) had health insurance. Pediatric TBI accounted for 0.03% of all surgical emergencies at LUTH. Road traffic accidents (RTAs) were the cause for TBI in 11 (42.3%) of cases, whereas falls (7, 26.9%) and household accidents (5, 19.2%) were leading non-RTA causes. Only one patient (3.8%) was selected by skilled personnel and received immediate C-spine stabilization. Only 15 (57.7%) had a CT scan, constrained by financial issues. Four (15.4%) required surgery, but only half of them could undergo surgery due to financial constraints. Only one patient needed ICU admission, and three patients (11.5%) died. Mortality was only seen in severe TBI cases.
Conclusion:
The study found a low prevalence of pediatric TBI but highlighted significant mortality, especially in severe cases. Poverty and lack of health insurance were major factors affecting outcomes.
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