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Published on: September 21, 2017
Pediatric road traffic accident - related head injury: a retrospective multicenter cohort study in Ghana
Anthony Baffour Appiah1, Till Bärnighausen2, Michael Lowery Wilson3
1Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany. anthony.baffour_appiah@stud.uni-heidelberg.de.
Insights
Over a quarter of pediatric road traffic accident patients with head injuries in Ghana had poor outcomes. Location, injury severity, and polytrauma were key predictors, highlighting the need for improved pediatric head injury care.
Area of Science:
- Trauma Surgery
- Pediatric Neurology
- Public Health
Background:
- Road traffic accidents (RTAs) are a leading cause of death, disability, and cognitive impairment in children due to head injuries (HIs).
- Identifying predictors of functional outcomes after pediatric HI is crucial for optimizing trauma care and reducing adverse events.
- This study focuses on pre-hospital and clinical factors influencing outcomes in pediatric RTA patients with HI.
Purpose of the Study:
- To examine predictors of unfavorable functional outcomes in pediatric patients (0-18 years) with head injuries from road traffic crashes.
- To identify specific pre-hospital and clinical factors associated with poor outcomes in this vulnerable population.
- To inform strategies for improving trauma care and patient management.
Main Methods:
- A retrospective cohort study involving 816 pediatric RTA patients with HI across three teaching hospitals in Ghana.
- Functional outcome was assessed using the Glasgow Outcome Scale (GOS), categorized as favorable (GOS 4-5) or unfavorable (GOS 1-3).
- Multivariable logistic regression and Kaplan-Meier analysis were employed to identify predictors and estimate mortality, with ROC curve analysis for predictive performance.
Main Results:
- 25.9% of pediatric patients experienced unfavorable inpatient outcomes, including 5.5% mortality and 20.3% severe disability.
- Significant predictors of unfavorable outcomes included hospital location in the Northern Region (AOR 26.89), polytrauma (AOR 1.94), unspecified head injuries (AOR 2.08), and Injury Severity Score (ISS) (AOR 1.04).
- ROC analysis indicated strong predictive performance (AUC 0.9107). Higher mortality risk was observed for severe injury (ISS > 15) and severe HI (GCS 3-8).
Conclusions:
- Over one-quarter of pediatric RTA patients with HI in Ghana faced unfavorable outcomes during hospitalization.
- Regional treatment disparities, polytrauma, increased injury severity, and non-specific HI diagnoses are independent predictors of poor outcomes.
- Enhanced diagnostic capabilities and early referral systems are vital for improving pediatric HI care, especially for polytrauma cases and in the Northern Region.
Background:
Head injuries (HIs) from road traffic accidents (RTAs) are major causes of death, long-term disability, and cognitive impairment in children. Evaluating significant predictors of functional outcomes after HI can help optimize trauma care and reduce the burden of unfavorable outcomes. This study examined the pre-hospital and clinical predictors of unfavorable outcomes in pediatric road traffic crash patients with HI (0-18 years).
Methods:
A retrospective cohort study of 816 pediatric RTA patients with HI presented at three teaching hospitals in the Northern, Ashanti, and Central Regions in Ghana. Functional outcome was assessed using the Glasgow Outcome Scale (GOS) at discharge, and categorized as either favorable (GOS 4-5) or unfavorable (GOS 1-3). A multivariable logistic regression model was used to identify predictors of unfavorable outcomes. The receiver operating characteristic (ROC) curve was used to assess the predictive performance of the multivariable logistic regression model. Kaplan-Meier failure analysis was used to estimate the cumulative incidence of HI-related inpatient mortality.
Results:
A total of 211 (25.9%) patients with HIs had an unfavorable inpatient outcome, including 45 (5.5%) deaths and 166 cases (20.3%) of severe disability. Significant predictors for higher odds of unfavorable outcomes were hospital location in the Northern Region (Adjusted odds ratio [AOR], 26.89; 95% confidence interval [CI], 10.87-66.53), patients with polytrauma (AOR = 1.94; 95% CI: 1.11-3.39) and those with unspecified head injuries (AOR = 2.08; 95% CI: 1.09-3.99), and ISS (AOR 1.04, 95% CI 1.00-1.07). The ROC curve showed a sensitivity of 69.52%, specificity of 94.81%, and an area under ROC curve of 0.9107. Kaplan-Meier analysis showed a higher cumulative probability of HI-related deaths for patients with severe injury (ISS > 15) and severe HI (GCS 3-8).
Conclusion:
Over one-quarter of pediatric RTA patients with HI in Ghana experienced unfavorable outcomes during hospitalization. Regional treatment location, greater injury severity, poly-trauma, and non-specific HI diagnoses independently predict unfavorable outcomes. These findings underscore the need to strengthen pediatric HI care through improved diagnostic capacity and early referral pathways, particularly for children with polytrauma and in the Northern Region.
