Mortality And Morbidity of Severe Traumatic Brain Injuries; A Pediatric Intensive Care Unit Experience Over 15 Years

Kam Lun Hon; Siwei Huang; Wai Sang Poon; Hon Ming Cheung; Patrick Ip; Benny Zee

doi:10.29252/beat-070308

Mortality And Morbidity of Severe Traumatic Brain Injuries; A Pediatric Intensive Care Unit Experience Over 15 Years

Bull Emerg Trauma. 2019 Jul;7(3):256-262. doi: 10.29252/beat-070308.

Authors

Kam Lun Hon¹, Siwei Huang², Wai Sang Poon³, Hon Ming Cheung¹, Patrick Ip⁴, Benny Zee²

Affiliations

¹ Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong.
² The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
³ Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
⁴ Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong.

Abstract

Objective: To determine the mortality, morbidity, types of intracranial hemorrhages, and factors associated with length of stay (LOS) associated with accidental traumatic brain injury (TBI) at a pediatric intensive care unit (PICU) of a regional trauma center in an Asian city.

Methods: This study is a retrospective review of types of head injury, mortality and morbidity demographics of patients admitted to a PICU with TBI. All patients with accidental TBI were included, namely road traffic injury (RTI) and fall, and their demographics compared. Non-accidental injuries (NAI) were excluded.

Results: 95 children (78% males) were admitted to a PICU with RTI or falls from 2002 to 2017. They accounted for 3.7% of PICU admissions. Comparing with falls, victims of RTI were older (p<0.001) and more likely to suffer from skull fracture (p=0.017). There were 4 deaths with falls (6.8%) but none with RTI. Subarachnoid hemorrhages, extradural hemorrhages, the use of mechanical ventilation, inotropes and neurological supports were associated with longer LOS in PICU in these injuries (p<0.001).

Conclusion: A longer PICU LOS is associated with extradural and subarachnoid hemorrhages, usage of inotropes, mechanical ventilation and neurological supports in falls and RTI. Three-quarters of victims are males. Preventive health education should be especially directed to boys to reduce severe TBI in this Asian city.

Keywords: Falls; Length of Stay; Mortality; PICU; Road traffic injury; Traumatic Brain injury.