gms | German Medical Science

Objective: Traumatic brain injury (TBI) is the leading cause of death and disability in children. It includes a range of different pathologies that differ considerably from adult TBI in regard to pathophysiology, injury patterns, and clinical management. Analyzing and understanding injury patterns of pediatric TBI is essential to finding and establishing new preventive efforts and public campaigns as well as to improve clinical management.

Methods: The multi-center prospectively collected Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core and registry databases were screened and patients were included when younger than 18 years at enrollment and admitted to the regular ward (admission stratum) or intensive care unit (ICU stratum) following TBI. Patient demographics, injury mechanisms, clinical findings, brain CT imaging details, and outcome (GOSE at 6-months follow-up) were retrieved from the core database and analyzed. Injury characteristics were compared between patients admitted to the regular ward and ICU. Results from the core study were compared to the registry dataset which includes larger patient numbers but no follow-up data.

Results: 227 patients in the core dataset and 687 patients in the registry dataset were included in this study. In the core dataset, road-traffic incidents were the most common cause of injury overall and in the ICU stratum, while incidental falls were most common in the admission stratum. Brain injury was considered serious to severe in the majority of patients and concurrent injuries in other body parts were very common. Intracranial pathologies were detected in 60% of initial brain CTs. Intra- and extracranial surgical interventions were performed in one fifth of patients. The overall mortality rate was 3% and the rate of unfavorable outcome 10%, with those numbers being considerably higher in the subgroup of ICU patients. Injury characteristics from the core study could be confirmed in the registry dataset.

Conclusion: Our study displays the most common injury mechanisms and characteristics of pediatric TBI in Europe. Road-traffic incidents were especially common in ICU patients and patients with severe TBI, indicating that preventive efforts such as advertising the use of safety helmets could be effective in decreasing the incidence of this serious condition in children.