Clinical Profile, Evaluation of Imaging Guidelines, and Management of Pediatric Traumatic Brain Injury at a Tertiary Care Center in India: A Review of 269 Patients

Abstract

Abstract Background: Traumatic brain injury (TBI) is associated with considerable morbidity and mortality in the pediatric population. Literature regarding management of TBI in children is scarce in the Indian setting. Our study aims to bridge the existing literary gap. Materials and Methods: This study is a retrospective analysis of 269 children below 12 years of age presenting to a tertiary care hospital in India with head injury between January 2018 and January 2021. Pearson’s χ2 test, Kruskal–Wallis test, and Mann–Whitney U-test were used for statistical analysis. Results: The mean age of children admitted with head injury was 4.7 years. TBI was mild in 92.2% of children. A fall from height was the most common cause of injury (81.8%). The most common finding on computed tomography (CT) was skull fracture in 38%. Ten children (3.8%) required neurosurgical intervention. The median duration of hospital stay was 4 days. Statistically significant differences in median duration of hospital stay were obtained based on skull fracture and Glasgow Coma Scale on arrival. About 43.1% (n = 116) of children received a CT scan despite lack of indication as per NICE (National Institute of Health Care and Excellence) guidelines, and positive findings were obtained in 47.4% (n = 55). Prophylactic anticonvulsants were given to 39.8% of children (n = 107), of which 86.8% (n = 92) had positive findings. Fourteen children (13.2%) with a normal CT scan received anticonvulsants due to the presence of seizures following head injury. Conclusion: Strict implementation of guidelines issued by NICE would have led to non-detection of intracranial injury in many patients. A modification of this guideline to suit the Indian perspective may be necessary. The use of anticonvulsants in children following head injury needs further characterization.