An audit of blunt head injuries sustained by children up to 10 years of age admitted to Chris Hani Baragwanath Academic Hospital

Abstract

Background. Traumatic brain injury (TBI) in the paediatric population is a significant contributor to death and disability worldwide. In Sub-Saharan Africa death and disability from TBI is still superseded by infectious disease. Mechanisms of injury differ by region and socio-economics, but in general falls, road traffic collisions (RTC), being “struck by/against objects” and non-accidental injuries (NAI) are responsible for most injuries. Objectives. To quantify the burden of TBI in terms of demographics, causes and severity. To explore resource utilisation regarding length of stay, computed tomography (CT) brain scan use, and multidisciplinary participation. To interrogate possible temporal patterns of injury. Thus, to identify potential targets for community-based prevention strategies. Methods.A 5-year retrospective review for all children under 10 years admitted with TBI between September 2013 and August 2018. Demographics, date of injury, mechanism of injury, severity of TBI based on Glasgow Coma Scale, and requirement for CT brain were collected for each patient. Outcomes were reported as discharge, transfer or death. Outcomes for children sustaining isolated TBI were compared to those sustaining TBI with polytrauma. Results. A total of 2 153 patients were included, with mean (SD) age of 4.6 (2.7) years and male to female ratio 1.7:1. RTC was the most frequent category at 59% (80% of these were pedestrian collisions), followed by falls at 24%. Mild TBI accounted for 87% of admissions, 6% moderate, and 7% severe injuries. Polytrauma was associated with increased severity of TBI. The cohort carried a 2.3% mortality. NAI accounted for 6% of injuries and carried a 4% mortality. Median (IQR) hospitalisation was 1 (1-3) days, ranging from less than 24 hours to 132 days. CT scans were performed on 43% of admitted patients and 48% of patients were consulted by another medical or allied medical discipline. Injuries were more frequent in summer months and on week-ends. Infants under a year of age were identified as a group particularly vulnerable to injury, specifically NAI. Conclusion. Paediatric TBI was demonstrated to be a resource intensive public health concern. From the results we identified potential primary prevention targets that could perhaps be incorporated into broader community-based intervention programs. We also identified a need to further study long-term consequences of mild TBI in our paediatric population.