Abstract
Traumatic brain injury (TBI) is the main cause of death in children around the world. The last Dutch epidemiological study described the incidence over 10 years ago. Mechanism of injury seems to change with the age of the child, therefore it is important to appreciate different age groups. To be able to lower the impact of childhood TBI, an understanding of current incidence, mechanism of injury and outcome is necessary. A nationwide retrospective cohort study was conducted. The Dutch National Trauma Database was used to identify all patients 18 years and younger who were admitted to a Dutch hospital with moderate-severe TBI (Abbreviated Injury Score≥3) in the Netherlands, from January 2015 until December 2017. Subanalyses were done for different age groups. In total, 1413 patients were included, of whom 5% died. The incidence rate of moderate-severe TBI was 14/100,000 person years. Median age was 10.4 years. Largest age group was patients <5 years, incidence rate was highest in patients ≥16 years. Falls were more common than road traffic accidents (RTA), but RTAs occurred far more frequently amongst children over 10. RTAs predominantly consisted of bicycle accidents. Mortality rates increased from youngest to oldest age groups, as did the chances of a Glasgow Outcome Scale score of 3. Paediatric moderate-severe TBI represents a significant problem in the Netherlands. Falls are the most common mechanism of injury amongst younger children and RTAs amongst older children. Unique for the Netherlands is the vast amount of bicycle accident related injuries.
Highlights
Traumatic brain injury (TBI) is the main cause of death in children around the world
Most children had a GCS of 15 if they had an AIS of the head region (AIShead) of 3 (73%), this dropped to 50% if the AIShead was 5 (Table 1)
Moderate and severe traumatic brain injury in the paediatric population is relatively common, with 1413 cases in 2015e2017 in the Netherlands. This leads to an incidence rate of 14/100,000 person years, which approaches the incidence of childhood cancers, which had an incidence rate of 17/100,000 person years in 2017 [16]
Summary
Traumatic brain injury (TBI) amongst children is quite common, with estimates of three million affected children globally every year and 35,000 annual hospitalisations in the United Kingdom [1,2]. In one area in the Netherlands, 130 patients were identified to have moderate or severe brain injury in 2008 and 2009 [4]. Distinct comparison of those epidemiological reports is difficult as classification of severity of TBI varies as do study design, cohort type and cohort size [1]. To be able to lower the impact of childhood TBI, an understanding of current incidence, mechanism of injury and outcome is necessary This would help to identify on which areas research and prevention methods should focus. We investigated the incidence, mechanism of injury, demographics and outcome of moderate and severe TBI requiring hospital admission amongst children of 18 years and younger, with a subanalysis of different age groups
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