A profile of children with traumatic brain injury admitted to the paediatric intensive care unit of Red Cross War Memorial Children's Hospital in Cape Town, South Africa, between 2015 and 2019.

Abstract

Background: Paediatric traumatic brain injury (TBI) is a public health problem with high morbidity and mortality.

Objectives: To highlight risk factors and describe associated morbidity and mortality of children admitted with TBI to the Paediatric Intensive Care Unit (PICU) at Red Cross War Memorial Children's Hospital, Cape Town.

Methods: We retrospectively documented the hospitalisation of all children with TBI admitted into our PICU between 2015 and 2019.

Results: Of 320 children identified, 314 were enrolled: 267 (85%) had severe TBI (Glasgow Coma Scale (GCS) ≤8), 36 (11.5%) moderate TBI (GCS 9 - 12) and 11 (3.5%) mild TBI (GCS ≥13). Median age was 6.5 (interquartile range (IQR) 3.5 - 8.9) years; 194 (61.8%) were male. Motor vehicle collisions accounted for 75% (235) of injuries. Two hundred and seventy-nine (88.9%) children were invasively ventilated for a median of 4.5 (IQR 1 - 8) days; 13.9% (38/273) had a failed extubation and 10.8% (30/277) required tracheostomies. One hundred and sixty-three children (52.2%, n=312) had intracranial pressure monitoring. Almost a third (81/257) required vasopressor support. Approximately 40% (113/286) developed trauma-related seizures; 15.4% (44/286) required a thiopentone infusion and 6% (17/280) a decompressive craniectomy. Common complications were as follows: 12.2% developed post-extubation stridor (34/279), 10.5% a hemiparesis (33/314) and 6.4% diabetes insipidus (19/298). Median PICU stay was 4 (IQR 1 - 10) days, and hospitalisation 11 (IQR 5 - 21) days. Ninety-three (29.6%) children were transferred for further rehabilitation; 38 (12.1%) died.

Conclusion: Children admitted to our PICU with TBI had considerable morbidity and mortality, but this is a marked improvement since the 1990s. Enhanced primary preventive strategies, especially for motor vehicle collisions, are imperative to prevent TBI in children.

Contribution of the study: Paediatric traumatic brain injury (TBI) is associated with considerable morbidity and mortality. Through our profile of children with TBI admitted to PICU, we hope to contribute to future guidance and interventions to improve the quality of care in this subset of patients.