Increased morbidity and mortality of traumatic brain injury in victims of nonaccidental trauma

Abstract

The purpose of this study was to determine if the morbidity and mortality associated with traumatic brain injury (TBI) are worse in children who experienced nonaccidental trauma (NAT) compared with TBI from other traumatic mechanisms. We identified all pediatric patients admitted with the diagnosis of TBI between 2001 and 2010 in our institutional trauma registry with an Abbreviated Injury Scale (AIS) score greater than 1. Patients were divided into groups based on a nonaccidental (NAT) or accidental mechanism of injury. Need for gastrostomy tube insertion was used as a marker of more severe neurologic morbidity in survivors of TBI. Group comparisons were made using Fisher's exact tests. A total of 2,782 patients with TBI were included; 315 (11.3%) patients had TBI secondary to NAT. Overall mortality and AIS-specific mortality were higher in patients with TBI secondary to NAT. In comparison with patients with TBI secondary to accidental mechanisms, patients with TBI secondary to NAT were younger (mean, 1 year vs. 8 years), had longer intensive care unit stays (mean, 3 days vs. 1 day), and required gastrostomy tubes more often (6% vs. 1%, p < 0.0001). Even among the subgroup of patients with severe TBI, (AIS score 4 and 5), patients with NAT required gastrostomy tubes more often (5% vs. 2%, p = 0.014). Patients with TBI from NAT have increased morbidity and mortality compared with patients with TBI from accidental mechanisms; these differences are present at all levels of severity of injury. Patients with TBI from NAT represent a vulnerable group of pediatric trauma patients who are at increased risk for death and worse outcome and who will require greater short- and long-term medical resources.