Epidemiology of Pediatric Traumatic Brain Injury at Sylvanus Olympio University Hospital of Lomé in Togo

Abstract

Introduction. Severe pediatric traumatic brain injury (pTBI) is a leading cause of disability and death in children worldwide. Children victims of pTBI are admitted to the Sylvanus Olympio University Hospital (SOUH) at the multipurpose Intensive Care Unit (ICU). We aimed in this study to describe the epidemiologic characteristics and outcomes of pTBI patients admitted in this ICU. Patients and Methods. This study was conducted at the ICU of SOUH of Lome. It was a retrospective study based on patients’ records from 0 to 15 years old admitted during the period from 1 January 2012 to 30 June 2018 (5 years and 6 months). Results. We recorded 91 pTBI included in the study. The mean age was 7.7 ± 4.3 years. The male predominated with 67.0%. Road traffic accidents were the most common cause (79.1%), followed by falls (19.8%). The average pediatric Glasgow Coma Scale (pGCS) was 6.6 ± 1.4, with a mean Injury Severity Score (ISS) of 23.1 ± 8.4. The most common brain injuries found in the CT scan were brain edema (72.9%), skull fracture (69.5%), and brain contusion (55.9%). The average duration under mechanical ventilation was 2.1 ± 2.9 days, and the mean ICU stay was 4.9 ± 4.4 days. Overall mortality was 31.9% (29 cases). Factors significantly associated (p<0.05) with death were hypotension (51.7%), anemia (43.1%), hyperthermia (46.7%), GCS < 6 (64%), and ISS > 20 (48.9%). Conclusion. pTBI mortality remains high in SOUH ICU. Factors associated with mortality were secondary systemic insults, worse GCS < 6, and ISS > 20.

Risk factors for positive brain CT scan in children with traumatic brain injury and GCS = 15

“…[ 7 – 10 ] TBI resulting from closed head injury (CHI) is one of the main causes of disability and death in children. [ 11 , 12 ] According to the Glasgow Coma Scale (GCS), TBI is usually divided into mild (GCS = 13–15), moderate (GCS = 9–12), and severe (GCS = 3–8). Children with mild TBI account for more than 80% of all injuries.…”

Estimated incidence and case fatality rate of traumatic brain injury among children (0–18 years) in Sub-Saharan Africa. A systematic review and meta-analysis

“…Thirty (30) complete articles were evaluated for eligibility and 13 papers (n = 40685) [ 4 , 17 , 12 , 23 – 32 ] met the inclusion criteria and were included in the final qualitative and meta-analysis. However, 4 studies [ 26 , 29 – 31 ] were included in the meta-analysis for the pooled incidence ( Fig 1 ).…”

“…This is not surprising as the study using US trauma registry used only severe children with TBI cases and hence expected that mortality should be high. In fact, studies have identified a strong correlation between severe TBI and in-hospital mortality [ 30 , 31 , 38 ]. The high case fatality in SSA could be ascribed to a variety of factors, including the high severity cases measured by GCS [i.e., 7.7% -40.2%] seen in the current review, infrastructural gap in pre-hospital and in-patients’ management that exist in the sub-region as well as the limited specialized Intensive Care Unit for neuro-surgical cases to manage high severe pediatric with TBI in SSA.…”

An analysis of neutrophil-to-lymphocyte ratios and monocyte-to-lymphocyte ratios with six-month prognosis after cerebral contusions

“…Among adults over 60 with TBI, cerebral contusions are found in around 18% of cases ( 5 ). In pediatric TBI, brain contusion (55.9%) is also frequently observed ( 6 ). These contusions not only cause loss of function but also pose a significant threat to healthy brain tissue due to the toxic nature of blood.…”