Clinico-epidemiological profile and factors predicting the outcome of pediatric isolated traumatic brain injury - a bicentric study in eastern india


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Suman Das., Suprit Basu., Subhajit Bhakta., Sarbartha Kumar Pratihar and Sreejata Mazumdar

Introduction: Traumatic brain injury (TBI) in infancy and childhood is documented as the single most common cause of death and also leads to functional disability and psychosocial maladjustments in the survivors.
Methods: In this retrospective, bi-centric study on clinico- epidemiological profile, outcome and prognostic factors of traumatic brain injury in pediatric patients, all the case records of 220 children aged <12 years were reviewed and pertinent data (basic demographic, clinical, biochemical, and radiological data on admission and during ICU stay) were collected. They were followed up on outpatient basis for 1 year. Categorized data were analyzed by Chi-square test. Continuous variable were evaluated by Student’s t-test. Risk factors were evaluated by multivariate analysis by a multiple logistic stepwise regression procedure. Odds ratios and risk ratios were estimated with their 95% confidence intervals (95%CI).
Results: Among 220 patients, 53.2%, 30.9% and15.9% suffered mild, moderate and severe head injury. 50% patients developed secondary systemic insults (SSIs). Neurosurgical procedures were needed in 25% cases. Mortality was 20%, brain herniation being the leading cause. Univariate analysis showed need for mechanical ventilation, anisocoria, SSIs, and low Glasgow Coma Scale scores to be the strongest predictors of mortality (p values<0.0001). Multivariate analysis showed that moderate [RR 1.7 (95% CI 1.3-2.1), p<0.0001] and severe head injury [RR 2.0 (95% CI 1.6-2.5), p<0.0001], hyponatremia [RR 1.4 (95% CI 1.2-1.8), p=0.005], nosocomial infections [RR 1.5 (95% CI 1.3-1.9), p=0.002] and presence of midline shift in CT brain [RR 1.7 (95% CI 1.3-2.1), p=0.004] were the independent risk factors for development of poor outcome. 49% had good outcome with low disability (Glasgow outcome score 5) and 7.2% had post-traumatic seizure disorder.
Conclusion: Head injury is commonest in 8-12 years age group, RTA being the commonest etiology, and mild injuries being the commonest type. Secondary systemic insults negatively affect outcome. GCS at admission can predict mortality, but it is not a significant predictor of long term outcome among survivors.

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