Abstract
(1) Background: Road traffic accidents (RTAs) are the leading cause of pediatric traumatic brain injury (TBI) and are associated with high mortality. Few studies have focused on RTA-related pediatric TBI. We conducted this study to analyze the clinical characteristics of RTA-related TBI in children and to identify early predictors of in-hospital mortality in children with severe TBI. (2) Methods: In this 15-year observational cohort study, a total of 618 children with RTA-related TBI were enrolled. We collected the patients’ clinical characteristics at the initial presentations in the emergency department (ED), including gender, age, types of road user, the motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and the intracranial computed tomography (CT) Rotterdam score, as potential mortality predictors. (3) Results: Compared with children exhibiting mild/moderate RTA-related TBI, those with severe RTA-related TBI were older and had a higher mortality rate (p < 0.001). The in-hospital mortality rate for severe RTA-related TBI children was 15.6%. Compared to children who survived, those who died in hospital had a higher incidence of presenting with hypothermia (p = 0.011), a lower mGCS score (p < 0.001), a longer initial prothrombin time (p < 0.013), hyperglycemia (p = 0.017), and a higher Rotterdam CT score (p < 0.001). Multivariate analyses showed that the mGCS score (adjusted odds ratio (OR): 2.00, 95% CI: 1.28–3.14, p = 0.002) and the Rotterdam CT score (adjusted OR: 2.58, 95% CI: 1.31–5.06, p = 0.006) were independent predictors of in-hospital mortality. (4) Conclusions: Children with RTA-related severe TBI had a high mortality rate. Patients who initially presented with hypothermia, a lower mGCS score, a prolonged prothrombin time, hyperglycemia, and a higher Rotterdam CT score in brain CT analyses were associated with in-hospital mortality. The mGCS and the Rotterdam CT scores were predictive of in-hospital mortality independently.
Highlights
Traumatic brain injury (TBI) is among the leading causes of mortality and morbidity in children and, globally, has large impacts on children’s health [1–4]
Patients who initially presented with hypothermia, a lower motor components of the Glasgow Coma Scale (mGCS) score, a prolonged prothrombin time, hyperglycemia, and a higher Rotterdam computed tomography (CT) score in brain CT analyses were associated with in-hospital mortality
Our study reveals some clinical characteristics for road traffic accidents (RTAs)-related TBI children with higher in-hospital mortality, including presenting to the emergency department (ED) with hypothermia, a lower mGCS score, laboratory findings of an elevated initial prothrombin time and hyperglycemia, and an initial brain CT with a higher Rotterdam CT score
Summary
Traumatic brain injury (TBI) is among the leading causes of mortality and morbidity in children and, globally, has large impacts on children’s health [1–4]. As transportation has improved in cities, road traffic accidents (RTAs) have become responsible for a significant proportion of pediatric TBIs. RTAs are the most frequent cause of severe TBI among young children worldwide [5] and are the leading cause of death for children and young adults aged 5–29 years, according to reports by the World Health Organization in 2021 [6]. Clinical characteristics, including young age, specific injury mechanism, a decreased Glasgow Coma Scale (GCS) score, reduced pupil reaction, hypotension, hypothermia, hyperglycemia, coagulation disorders, and neuroimaging discoveries of subdural hemorrhage, subarachnoid hemorrhage, parenchymal hemorrhage, brain edema, and mass effects, are reported predictors of mortality and poor outcomes in pediatric TBI [7–16]. Most studies have used all injury mechanisms of pediatric TBI, including falls, being struck by/against an object, RTA, assault, and sports, but different injury mechanisms may have different clinical presentations, and predictors of poor outcomes may vary [17,18]
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