Traumatic Brain Injury in Paediatrics

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Introduction

Traumatic brain injury (TBI) is the leading cause of death and disability in children. TBI in children result in a range of traumatic injuries to the scalp, skull, and brain that are comparable to those in adults but differ in both pathophysiology and management.Although children have better survival rates than adults with TBI, the long-term sequelae and consequences are often more devastating in children because of their age and developmental potential.Evidence suggests that children exhibit a specific pathological response to TBI with distinct accompanying neurological symptoms, and considerable efforts have been made to elucidate their pathophysiology. In addition, recent technical advances in diagnostic imaging of pediatric TBI has facilitated accurate diagnosis, appropriate treatment, prevention of complications, and helped predict long-term outcomes.The costs involved in the care of a child with severe TBI,extended over the individual’s lifetime, are significant.

Incidence

• Unintentional injuries are the leading cause of death in children.
• Of all the types of traumatic injuries, brain injuries are the most likely to result in death or permanent disability. 
• A study with respect to age revealed that emergency consultations were most common among children aged 0–4 years (1,035 per 100,000 children), and of these, 80 per 100,000 children were hospitalized.
• The annual death rate from traumatic injury in children <4 years is 5 per 100,000.
• The death rate is higher for children <4 years than for those 5–14 years of age.
• Hospitalization for TBI was most commonly observed in adolescents (129 per 100,000).
• More boys were found to undergo emergency consultation and hospitalization than girls.
• The most common mechanisms of pediatric TBI vary according to age. Falls are the leading cause of TBI in children younger than 14 years of age. Children younger than 4 years of age are injured mainly by falls but are also affected by abusive injuries and motor vehicle accidents.

Characteristics of injury

The clinical presentation of children with head injury is extremely variable depending on the severity of trauma. The Pediatric Glasgow Coma Scale (PGCS) is commonly used to assess consciousness and to define the severity of head injuries. Generally, neurological deficits are found at the time of injury, and newly appeared clinical signs may indicate further progression of pathological changes due to head injuries and should be carefully investigated. The following table represents the injury characteristics according to age and development-

Newborns

Delivery head injury Intracranial hemorrhages Cephalic hematoma Subgaleal hematoma

Infants

Accidental head injury Abusive Head Trauma

Toddlers and School children

Accidental head injury

Adolescents

Bicycle and motorcycle-related accidents Sports-related head injuries

Classification

Head traumas are classified by the nature of the force that causes the injury and the severity of the injury. Forces that cause head trauma are referred to as either impact or inertial forces. Impact forces result from the head striking a surface or a moving object striking the head; these forces most often cause skull fractures, focal brain lesions, and epidural hematomas. Inertial forces are typically the result of rapid acceleration and deceleration of the brain inside the skull resulting in a shearing or tearing of brain tissue and nerve fibers.

Most TBIs are the result of both types of forces. The severity of head injury is rated as a range, from relatively mild concussion to more serious injury. Damage to nervous system tissue occurs both at the time of impact or penetration and through secondary damage.

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