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A Retrospective Cohort Study of Traumatic Brain Injury in Children: A Single-Institution Experience and Determinants of Neurologic Outcome

Merve Misirlioglu
Merve Misirlioglu
, 
Faruk Ekinci
Faruk Ekinci
, 
Dincer Yildizdas
Dincer Yildizdas
, 
Ozden Ozgur Horoz
Ozden Ozgur Horoz
, 
Hayri Levent Yilmaz
Hayri Levent Yilmaz
, 
Faruk Incecik
Faruk Incecik
, 
Mazhar Ozsoy
Mazhar Ozsoy
, 
Ahmet Yontem
Ahmet Yontem
, 
Sevcan Bilen
Sevcan Bilen
 and 
Sena Silay
Sena Silay
   | Nov 14, 2023
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Article Category: Research Article
Published Online: Nov 14, 2023
Page range: 252 - 261
Received: Jun 17, 2023
Accepted: Sep 19, 2023
DOI: https://doi.org/10.2478/jccm-2023-0027
Keywords
© 2023 Merve Misirlioglu et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1.

Distribution of trauma cases by hours of the day in TBI patients
Distribution of trauma cases by hours of the day in TBI patients

Fig. 2.

Distribution of trauma cases by months of the year in TBI patients
Distribution of trauma cases by months of the year in TBI patients

Fig. 3.

Etiology of TBI in different age groups
Etiology of TBI in different age groups

Comparison of different scoring systems of the TBI patients according to the presence of early, and late enteral feeding

Parameter Enteral feeding p
<48th hour of hospitalization (n=65) >48th hour of hospitalization (n=25)
PRISM 5 (0–25) 6 (1–27) 0.124
PDR (%) 1.6 (0.5–59) 2.1 (0.4–52.8) 0.296
PIM3 2 (0.7–27) 2.2 (0.9–11) 0.182
Pediatric Trauma Score 10 (−1–12) 9 (1–12) 0.139
Injury severity score 5 (1–50) 10 (2–41) 0.001
GCS 13 (2–15) 13 (5–15) 0.985
GOS at discharge 5 (1–5) 5 (3–5) 0.340
GOS at 3rd month 5 (1–5) 5 (3–5) 0.238
Favorable GOS at discharge 46 (70.8) 15 (60) 0.327
Favorable GOS at 3rd month 50 (76.9) 16 (64) 0.214

Comparison of demographic and clinical properties between patients with favorable outcome and disability according to Glasgow Outcome Score (GOS) 3 months after TBI

Parameter GOS at 3rd month p
GOS=5 (n=66) GOS≤4 (n=24)
Age 4.9 (0.3–17.5) 6.1 (0.2–17.5) 0.942
Gender (female) 29 (43.9) 8 (33.3) 0.366
Multisystemic trauma 37 (56.1) 19 (79.2) 0.046
Trauma localization in multisystemic trauma
Extremity trauma 20 (30.3) 6 (25) 0.624
Pelvic trauma 6 (9.1) 2 (8.3) 0.911
Thorax trauma 14 (21.2) 16 (66.7) 0.001
Abdominal trauma 12 (18.2) 9 (37.5) 0.054
Facial trauma 17 (25.8) 6 (25) 0.942
Vertebral trauma 7 (10.6) 1 (4.2) 0.342
Altered consciousness 37 (56.1) 22 (91.7) 0.002
Seizure 5 (7.6) 11 (45.8) 0.001
CT/MRI findings
Skull fracture 46 (69.7) 12 (50) 0.084
Brain contusion 26 (39.4) 23 (95.8) 0.001
Subarachnoid hemorrhage 4 (6.1) 5 (20.8) 0.039
Subdural hemorrhage 9 (13.6) 10 (41.7) 0.004
Epidural hemorrhage 9 (13.6) 5 (20.8) 0.405
Intraparenchymal hemorrhage 7 (10.6) 6 (25) 0.086
Brain edema 31 (47) 13 (54.2) 0.546
Diffuse axonal injury 0 5 (28) 0.001
Shock treatment in ED 5 (7.6) 5 (20.8) 0.077
Inotropic drug in ED 1 (1.5) 3 (12.5) 0.025
Blood products in 48 h 16 (24.2) 16 (66.7) 0.001
Cranial surgery in 24 h 4 (6.1) 6 (25) 0.011
Other surgery in 24 h 11 (16.7) 6 (25) 0.372
CPR in the first 24h of hospitalization 0 3 (12.5) 0.003
MV in the first 24h of hospitalization 1 (1.5) 15 (62.5) 0.001
Nosocomial infections 2 (3) 12 (50) 0.001
PICU stay 2 (1–12) 9 (2–47) 0.001
Length of hospitalization 5 (2–33) 16.5 (6–60) 0.001
MV duration 1 (1–4) 5 (1–28) 0.061
PRISM 4 (0–18) 16 (4–27) 0.001
PDR (%) 1.5 (0.4–25.5) 15.5 (0–59) 0.001
PIM3 1.8 (0.7–8) 6.8 (1.2–27) 0.001
Pediatric Trauma score (PTS) 10 (6–12) 5 (−1–11) 0.001
Injury severity score (ISS) 5 (1–24) 15 (4–50) 0.001
GCS at admission 15 (2–15) 8 (4–15) 0.001

Comparison of demographic and clinical parameters between patients according to the presence of early, and late enteral feeding

<48th hour of hospitalization (n=65) >48th hour of hospitalization (n=25) p
Age (year), median 5.08 (0.25–17.5) 7.58 (0.67–17.5) 0.063
Gender (female) 25 (38.5) 12 (48) 0.410
Trauma localization
Multisystemic trauma 32 (49.2) 24 (96) 0.001
Extremity trauma 11 (16.9) 15 (60) 0.001
Pelvic trauma 1 (1.5) 7 (28) 0.001
Thorax trauma 20 (30.8) 10 (40) 0.405
Abdominal trauma 8 (12.3) 13 (52) 0.001
Facial trauma 11 (16.9) 12 (48) 0.002
Vertebral trauma 4 (6.2) 4 (16) 0.142
CT/MRI findings
Skull fracture 40 (61.5) 18 (72) 0.353
Brain contusion 7 (10.8) 3 (12) 0.868
Subarachnoid hemorrhage 5 (7.7) 4 (16) 0.239
Subdural hemorrhage 15 (23.1) 4 (16) 0.461
Epidural hemorrhage 11(16.9) 3 (12) 0.564
Intraparenchymal hemorrhage 10 (15.4) 3 (12) 0.682
Brain edema 31 (47.7) 13 (52) 0.714
Diffuse axonal injury 5 (7.7) 0 0.067
First 24 hours
Blood products 19 (29.2) 13 (52) 0.043
Cranial surgery 8 (12.3) 2 (8) 0.560
Other surgery 6 (9.2) 11 (44) 0.001
CPR 1 (1.5) 2 (8) 0.128
Mechanical ventilation 11 (16.9) 5(20) 0.732
Nosocomial infection 10 (15.4) 4 (16) 0.943
PICU stay 3 (1–28) 5 (1–47) 0.272
Length of hospitalization 5 (2–43) 10 (5–60) 0.001

The causes, locations, and clinical features of traumatic brain injury in 90 children

Causes n % Locations n %
Road traffic accidents 39 43.3 Outdoor 67 74.4
Passenger 12 13.3 Home 21 23.3
Pedestrian 27 30 School 2 2.2
Fall from height 34 37.8 CT/MRI findings n %
Cyclist 9 10 Skull fracture 58 64.4
Falling object 4 4.4 Brain edema 44 48.9
Basic fall 3 3.3 Subdural hemorrhage 19 21.1
Other 1 1.1 Epidural hemorrhage 14 15.6
Sign and symptoms n % Intraparenchymal hemorrhage 13 14.4
Altered consciousness 59 65.6 Brain contusion 10 11.1
Nausea/Vomiting 28 31.1 Subarachnoid hemorrhage 9 10
Seizure 16 17.8 Diffuse axonal injury 5 5.6
Headache 9 10 Minimal brain edema 5 5.6
Amnesia 2 2.2
Asymptomatic 6 6.7

Multiple logistic regression analysis of variables associated with outcome according to the 3rd month GOS in traumatic brain injury patients

Variables B S.E. P OR (95% CI)
Diffuse axonal injury −0.281 0.243 0.001 2.62 (1.83–3.74)
CPR in the first 24h of hospitalization −0.339 0.503 0.005 1.62 (1.13–2.74)
PIM3 −0.285 0.023 0.023 1.56 (0.40–6.19)
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