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Survival and Functional Outcomes at Discharge following Traumatic Brain Injury in Children versus Adults in a Resource-poor Setting.

L. Purcell,R. Reiss,Jessica C. Eaton,K. Kumwenda,C. Quinsey,A. Charles

Published 2020 in World Neurosurgery

ABSTRACT

INTRODUCTION Over 90% of trauma mortality occurs in low- and middle-income countries (LMIC), especially in sub-Saharan Africa. Head injury is the primary driver of trauma mortality in the pre- and in-hospital setting. METHODS An observational study was performed on patients presenting with Traumatic Brain Injury (TBI) from October 2016 through May 2017 at Kamuzu Central Hospital, Malawi. Bivariate analysis and logistic regression were performed to determine the odds of favorable functional outcomes and mortality after controlling for significant covariates. RESULTS Of the 356 patients with TBI, 72 (20.2%) were children <18 years of age. Males composed 202 (87.1%) and 46 (63.9%) of the adult and pediatric cohorts, respectively. Motor vehicle crash (MVC) was the leading etiology in adults and children. There was no significant difference between adult and pediatric GCS on admission, 10.8 ± 3.9 vs. 10.9 ± 3.5, respectively (p=0.8). More adult (n=76, 32.3%) than pediatric (n=13, 18.1%) patients died. On multivariable analysis, pediatric patients were more likely to have a favorable outcome defined by a Glasgow Outcome Scale of good recovery or moderate disability (OR 3.70, 95% CI 1.22 - 11.17, p=0.02) and were less likely to die after TBI (OR 0.29, 95% CI 0.09 - 0.93, p=0.04). CONCLUSION We show a survival advantage and better functional outcomes in children following TBI. This may be attributable to increased resiliency to TBI in children or the prioritization of children in a resource-poor environment. Investments in neurosurgical care following TBI are needed to improve outcomes.

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