Identification of risk factors for disabilities in children following traumatic brain injury: a prospective cohort study

Hassan Kadri; Diana Asmar; Huda Daood; Barah Hussain; Tim Kadri

doi:10.18203/2349-3291.ijcp20251090

Authors

Hassan Kadri Department of Neurosurgery, Children’s University Hospital, Damascus University, Syria
Diana Asmar Department of Neurosurgery, Children’s University Hospital, Damascus University, Syria
Huda Daood Department of ICU, Children’s University Hospital, Faculty of Medicine, Damascus University, Syria
Barah Hussain Department of ICU, Children’s University Hospital, Faculty of Medicine, Damascus University, Syria
Tim Kadri Department of Biology, George Washington University, Washington DC, USA

DOI:

https://doi.org/10.18203/2349-3291.ijcp20251090

Keywords:

Childhood, Morbidity, Mortality risk factors, Traumatic brain injury

Abstract

Background: Head injury is a common occurrence in children and is one of the leading causes of death and disability in this age group. Accurately predicting the outcome of children with head injuries is critical for appropriate treatment and management of these patients. The aim of this study was to determine the risk factors that can help predict the outcome of children who have been admitted for a clinically significant head injury.

Methods: We prospectively analyzed the data of 65 patients under the age of 13 years who were admitted to our hospital after a clinically significant traumatic brain injury (TBI). We statistically analyzed various parameters, such as age, gender, mechanism of trauma, consciousness level, convulsion, vomiting, radiological investigation, duration of hospitalization and the need for mechanical ventilation.

Results: The parameters that had significant predictive value for the final outcome included the mechanism of trauma, consciousness level, convulsion, radiological results, duration of hospitalization and the need for mechanical ventilation. However, age, gender and vomiting had no significant predictive value.

Conclusions: Our findings suggest that it is possible to predict the outcome of children with head injuries accurately by considering certain risk factors. This could aid in providing appropriate treatment and management of these patients, which is critical for their recovery and rehabilitation. Further studies with larger sample sizes are needed to confirm our findings.

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References

Beers SR, Wisniewski SR. Validity of a pediatric version of the Glasgow outcome scale–extended. J Neurotrauma. 2012;29(6):1126–39. DOI: https://doi.org/10.1089/neu.2011.2272

Theodorou CM, Nuño M, Yamashiro KJ, Brown EG. Increased mortality in very young children with traumatic brain injury due to abuse: a nationwide analysis of 10,965 patients. J of Ped Surg. 2021;56(6):1174-9. DOI: https://doi.org/10.1016/j.jpedsurg.2021.02.044

Forsyth R, Kirkham F. Predicting outcome after childhood brain injury. CMAJ. 2012;184(11):1257-64. DOI: https://doi.org/10.1503/cmaj.111045

Ongun EA, Dursun O. Prediction of mortality in pediatric traumatic brain injury: implementations from a tertiary pediatric intensive care facility. Ulusal Travma Ve Acil Cerrahi Dergisi. 2018;24(3):199-206.

Robert M. Nelson textbook of pediatrics. 2020.

Jankowitz BT, Adelson PD. Pediatric traumatic brain injury: past, present and future. Dev Neurosci. 2006;28(5):264-75. DOI: https://doi.org/10.1159/000094153

Bruce DA, Raphaely RC, Goldberg AI, Zimmerman RA, Bilaniuk LT, Schut L, et al. Pathophysiology, treatment and outcome following severe head injury in children. Childs Brain 1981;5:174–91.

Farmer JE, Clippard DS, Luehr-Wiemann Y, Wright E, Owings S. Assessing children with traumatic brain injury during rehabilitation: promoting school and community re-entry. J Learn Disabil. 1070;29:532–48. DOI: https://doi.org/10.1177/002221949602900508

Fulkerson DH, White IK, Rees JM, Baumanis MM, Smith JL, Ackerman LL, et al. Analysis of Long-Term (Median 10.5 Years) Outcomes in Children Presenting with Traumatic Brain Injury and an Initial Glasgow Coma Scale Score of 3 or 4. J Neurosurg Pediatr. 2015;16:410–9. DOI: https://doi.org/10.3171/2015.3.PEDS14679

Bonfield CM, Naran S, Adetayo OA, Pollack IF, Losee JE. Pediatric Skull Fractures: The Need for Surgical Intervention, Characteristics, Complications and Outcomes. J Neurosurg Pediatr. 2014;14:205–11. DOI: https://doi.org/10.3171/2014.5.PEDS13414

Orman G, Wagner MW, Seeburg D, Zamora CA, Oshmyansky A, Tekes A, et al. Pediatric skull fracture diagnosis: should 3D CT reconstructions be added as routine imaging. J Neurosurg Pediatr 2015;16:426–31. DOI: https://doi.org/10.3171/2015.3.PEDS1553

Araki T, Yokota H, Akio M. Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis and Management. Neurol Med Chir (Tokyo). 2017;57(2):82–93. DOI: https://doi.org/10.2176/nmc.ra.2016-0191

Singounas EG. Severe Head Injury in a Paediatric Population. J Neurosurg Sci. 1992;36:201–6.

Binder H, Majdan M. Management and outcome of traumatic intracerebral hemorrhage in 79 infants and children from a single level 1. Trauma Center Children (Basel). 2021;8(10):854.

Lang DA, Teasdale GM, Macpherson P, Lawrence A. Diffuse brain swelling after head injury: more often malignant in adults than children. J Neurosurg. 1994;80:675–80. DOI: https://doi.org/10.3171/jns.1994.80.4.0675

Bruce DA, Alavi A, Bilaniuk L, Dolinskas C, Obrist W, Uzzell B. Diffuse cerebral swelling following head injuries in children: the syndrome of “malignant brain edema. J Neurosurg. 1981;54:170–8. DOI: https://doi.org/10.3171/jns.1981.54.2.0170

Bruce DA, Raphaely RC, Goldberg AI, Zimmerman RA, Bilaniuk LT, Schut L, et al. Pathophysiology, treatment and outcome following severe head injury in children. Childs Brain. 1979;5:174–91. DOI: https://doi.org/10.1159/000119817

Afsaneh J, Sadat MRR. Diagnosing skull fracture in children with closed head injury using point-of-care ultrasound vs. computed tomography scan. Eur J Pediatr. 2021;180(2):477-84. DOI: https://doi.org/10.1007/s00431-020-03851-w

Esparza J, M-Portillo J, Sarabia M, Yuste JA. Outcome in children with severe head. Diagnosing Skull Fracture in Children with Closed Head Injury Injuries. Childs Nerv Syst 1985;1:109–114, DOI: https://doi.org/10.1007/BF00706691

Ellis HKL, Huang S, Sang PW, Ming CH, Zee B. Mortality and morbidity of severe traumatic brain injuries: a pediatric ICU experience over 15 years. Bulletin of Emerg and Trauma. 2019;7(3):256-62. DOI: https://doi.org/10.29252/beat-070308

Robba C. Mechanical ventilation in patients with acute brain injury: recommendations of the European society of intensive care medicine consensus. Intensive Care Med. 2020;46(12):2397–410. DOI: https://doi.org/10.1007/s00134-020-06283-0

Knettel BA, Knettel CT. Predictors of ICU admission and patient outcome for traumatic brain injury in a Tanzanian referral hospital: implications for improving treatment guidelines. Injury. 2022;53(6):1954-60. DOI: https://doi.org/10.1016/j.injury.2022.03.043

Statler BK, Dewitt PE. Seizures in children with severe traumatic brain injury. Pediatr Crit Care Med. 2017;18(1):54–63. DOI: https://doi.org/10.1097/PCC.0000000000000948

Harper JA, Klassen TP. Characteristics of Vomiting as a Predictor of Intracranial Injury in Pediatric Minor Head Injury. CJEM. 2020;22(6):793–801. DOI: https://doi.org/10.1017/cem.2020.378

Lo WD, Lee J, Rusin J, Perkins E, Roach ES. Intracranial Hemorrhage in Children: An Evolving Spectrum. Arch Neurol. 2008;65:1629–33. DOI: https://doi.org/10.1001/archneurol.2008.502

Binder H, Majdan M, Leitgeb J. Management and outcome of traumatic intracerebral hemorrhage in 79 infants and children from a single level 1 trauma center. Children. 2021;8(10):854. DOI: https://doi.org/10.3390/children8100854

Abujaber A, Fadlalla A. Prediction of In-Hospital Mortality in Patients On Mechanical Ventilation Post Traumatic Brain Injury: Machine Learning Approach. BMC Medical Informatics and Decision Making. 2010;4:56-8.