Neutrophil-to-Lymphocyte Ratio as a Predictor of Outcome in Pediatric Traumatic Brain Injury: A Systematic Review

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Abstract Traumatic brain injury (TBI) is a significant concern in children, with various prognostic methods used, including the neutrophil-to-lymphocyte ratio (NLR). While studies in adults show the usefulness of NLR, limited data exists for children. Physiological differences in pediatric TBI may render adult criteria inapplicable. This systematic review aims to collect evidence from articles on NLR use in pediatric TBI, addressing knowledge gaps and providing insights specific to children. To gather and synthesize information on the use of NLR in prognosticating pediatric brain injuries. Following PRISMA guidelines, we conducted a systematic literature search across PubMed, SCOPUS, Cochrane Library, and ScienceDirect to identify relevant studies on the NLR in pediatric TBI for prognostication. Inclusion criteria comprised randomized controlled trials, prospective, and retrospective studies, while exclusion criteria ruled out case series, reports, editorials, comments, animal studies, and non-English literature. Extracted details included study characteristics, NLR measurement methods, inclusion/exclusion criteria, outcomes, and correlations. Bias was assessed using the revised JBI critical appraisal tool in alignment with study characteristics. This systematic review initially included 20 studies, narrowed down to 7 for qualitative synthesis. Spanning from 2020 to 2023, these studies involved 1462 pediatric patients under 18 years. NLR measurements and outcomes varied across the studies (e.g., GOS, GOS-E peds, GCS, PTA, CT, and PCPCS). Due to variability in reporting and NLR collection times, meta-analysis was not feasible. Individual studies demonstrated NLR correlations with diverse outcomes, and all seven studies had a low risk of bias in quality assessment. NLR shows promise as a predictive marker for pediatric TBI outcomes, but the limited literature with methodological variations underscores the need for prospective studies with standardized protocols. Caution is advised in interpreting NLR values until validated through rigorous research methodologies.