Pattern and Outcome of Pediatric Traumatic Brain Injury: A Prospective Cohort Study at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia

Abstract

Background Traumatic brain injury (TBI), a major public health problem, is the most common cause of death/disability in children. Glasgow coma scale is used to assess, decide treatment and follow up of TBI. TBI causes and outcome data are scarce from sub-Saharan Africa, non-existent from Ethiopia. We aimed to document pattern and predictors of childhood TBI outcome in a teaching hospital, Southern Ethiopia. METHODS Prospective cohort study was conducted from September 2017 to September 2018 among pediatrics TBI presented to Hawassa University Hospital. Data were collected by structured questionnaires and analyzed using SPSS version 20. Logistic regression was carried out and significant associations were declared at p-value of < 0.05. RESULT During 1year period there were 4258 emergency room(ER) visits, TBI contributed to 317(7.4%) cases. The mean age of study subjects was 7.66±3.88 years. Boys, predominantly above 5years of age, comprise 218(68.8%) of study subjects with male to female ratio of 2.2:1. Pedestrian RTA 119 (37.5%) and falls 104 (32.8%) were the commonest causes of TBI. Mild, moderate, and severe TBI were documented in 231(72.9%), 61(19.2%), and 25(7.9%) of cases respectively. Most of TBI cases presented within 24hrs of injury 258(81.4%). Recovery with no neurologic deficit, 267(84.2%); focal neurologic deficit, 30(9.5%); depressed mentation, 10(3.2%) and death 10(3.2%) were documented. Presence of increased intracranial pressure(ICP) at admission [AOR: 1.415 (95% CI: 0.458-9.557)], severe TBI [AOR: 2.103 (95% CI: 0.965-4.524)], presence of hyperglycemia [AOR: 2.318 (95% CI: 0.873-7.874)] and head computed tomographic(CT) scans of contusion, diffuse axonal injury (DAI) or intracranial bleeding [AOR: 2.45 (95% CI: 0.811-7.952)] were found to be predictors of TBI outcome. CONCLUSION TBI contributed to 7.4% of pediatric ER visits. Boys above 5years of age were highly affected. Pedestrian RTA and falls, early presentation (<24hrs of injury) and mild form of TBI were the common documented patterns. Presence of increased ICP, hyperglycemia, severe TBI and CT findings of contusion, DAI/intracranial bleeding were predictors of poor outcome. Public awareness on road safety, childhood safety in preventing falls/animal injuries, closer follow-up of TBI cases for ICP and glycemic controls are recommended.