T. J. Zens1, S. Chaiet2,3, A. Rogers1, J. Kohler1, Y. Shan4, C. M. Leys1 1University Of Wisconsin,Pediatric Surgery,Madison, WI, USA 2Univeristy Of Tennessee Health Science Center,Otolaryngology-Head & Neck Surgery,Memphis, TN, USA 3University Of Wisconsin,Otolaryngology-Head & Neck Surgery,Madison, WI, USA 4University Of Wisconsin,Statistics,Madison, WI, USA
Introduction:
Pediatric traumatic brain injuries (TBI) result in significant morbidity and mortality. Our study aims to better understand national demographics for children with TBI, as well as, the role of safety belts and helmets in prevention of TBI.
Methods:
An analysis of the National Trauma Data Bank was conducted from 2007-2012. ICD-9 codes were used to identify children with the following types of TBI: concussion, cerebral contusion, brainstem contusion, subarachnoid hemorrhage, subdural hemorrhage, and extradural hemorrhage. The children were divided into groups (<1 year, 1-3 years, 4-7 years, 8-12 years, 13-15 years, and 16-18 years). Demographics data and outcomes measures were determined for each group. Using a logistic regression model and controlling for patient gender, race, ISS, and hospital pediatric trauma designation, odds ratios (OR) were calculated to determine the effectiveness of protective devices such as safety belts after motor vehicle collision (MVC), and helmets after motorcycle, ATV and bicycle accidents.
Results:
204,468 children with TBI were included in the analysis. Children <1 year and >13 years had the highest rates of TBI. The most common mechanism of injury across all age groups was motor vehicle crashes (MVC), except in children <1 year where falls were most common (52.9%). Mean ISS (14.4±12.3), ICU days (5.4±7.7), and mortality (5.0%±8.7%) was highest in children 16-18 years. Only, 30% of children with TBI were treated at a level trauma 1 peds center. Children 13-15 years old with TBI were least likely to be wearing a safety belt (23.6%) and children <1 years old were most likely (51.8%). Odds ratios for each age group demonstrated that children not wearing safety belts were more likely to die in MVCs than those wearing safety belts (OR 1.44-2.42). Similarly, the rates of helmet use in children with head injuries ranged from only 4.5-23.5% in children involved in ATV crashes, 9-12.4% in children involved in bicycle crashes, and 12-47% in children in motorcycle crashes. Despite this fact, those children in motorcycle, ATV, and bicycle accidents not wearing helmets were more likely to sustain a head injury than those wearing helmets (OR 1.5-2) in all age groups of children >1 yr old.
Conclusion:
Pediatric TBI account for almost 20% of trauma cases and carry significant morbidity and mortality. When examining children with TBI after trauma, less than 50% are wearing safety belts and helmets despite the fact that these safety devices remain an extremely effective protective mechanism for children. More education and legislation is still needed to promote the use of protective devices in children.
