Perspective on Paediatric Traumatic Brain Injury

Abstract

Background: Traumatic brain injury is an important aspect of paediatric trauma because of its contribution to mortality ant post trauma sequelae. Management of traumatic brain injury remains a challenge to surgeons, especially in developing countries. This study aims to determine the pattern of traumatic brain injury among children. Patients and Methods: A retrospective study of a total of 112 children with severe closed head injury was carried out during a fifteen year period at the Jos University Teaching Hospital to comparatively evaluate the epidemiology, clinical presentation and outcome of 42 children aged (4 months to 6 years) in the pre-school age (PSA) versus 70 others aged (6. – 13 years) in the school age (SA) bracket. Results: Male to female ratio for PSA was 5:1 versus 4:1 for SA. Road traffic accident (RTA) accounted for a total of 69% of pediatric traumatic brain injury (PTBI). PSA children were less frequently involved in RTA as occupants (15 % versus 56% in SA) but more frequently involved as pedestrians (45% versus 4% respectively). Falls constituted 19% of the total, involving relatively more patients in PSA (36 %t versus 9% in SA). Neck stiffness occurred in a total of 63%, 71% in PSA group versus 59% in SA group. Restlessness was observed in a total of 18%, 29% in PSA compared with 11% in SA. Intracranial hematomas occurred in a total of 29% with sub-dural hematomas predominating in PSA than in SA (32% versus 15%). Coma ranged from 5 weeks in PSA to 3 weeks in SA, with a mean of 4.2 weeks for both groups. A poor outcome (Glasgow outcome score 1, 2,3) was recorded in a total of 20% with a relative majority of patients in PSA (29 % versus 15%). Conclusion: Road traffic accident was responsible for most of the traumatic brain injury in children, especially among the school age group. Traumatic brain injury is associated with high mortality rate in children.