Pediatric road traffic accident – related head injury: a retrospective multicenter cohort study in Ghana

BACKGROUND: Head injuries (HIs) from road traffic accidents (RTAs) are major causes of death, long-term disability, and cognitive impairment in children. Evaluating significant predictors of functional outcomes after HI can help optimize trauma care and reduce the burden of unfavorable outcomes. This study examined the pre-hospital and clinical predictors of unfavorable outcomes in pediatric road traffic crash patients with HI (0-18 years). METHODS: A retrospective cohort study of 816 pediatric RTA patients with HI presented at three teaching hospitals in the Northern, Ashanti, and Central Regions in Ghana. Functional outcome was assessed using the Glasgow Outcome Scale (GOS) at discharge, and categorized as either favorable (GOS 4-5) or unfavorable (GOS 1-3). A multivariable logistic regression model was used to identify predictors of unfavorable outcomes. The receiver operating characteristic (ROC) curve was used to assess the predictive performance of the multivariable logistic regression model. Kaplan-Meier failure analysis was used to estimate the cumulative incidence of HI-related inpatient mortality. RESULTS: A total of 211 (25.9%) patients with HIs had an unfavorable inpatient outcome, including 45 (5.5%) deaths and 166 cases (20.3%) of severe disability. Significant predictors for higher odds of unfavorable outcomes were hospital location in the Northern Region (Adjusted odds ratio [AOR], 26.89; 95% confidence interval [CI], 10.87-66.53), patients with polytrauma (AOR = 1.94; 95% CI: 1.11-3.39) and those with unspecified head injuries (AOR = 2.08; 95% CI: 1.09-3.99), and ISS (AOR 1.04, 95% CI 1.00-1.07). The ROC curve showed a sensitivity of 69.52%, specificity of 94.81%, and an area under ROC curve of 0.9107. Kaplan-Meier analysis showed a higher cumulative probability of HI-related deaths for patients with severe injury (ISS > 15) and severe HI (GCS 3-8). CONCLUSION: Over one-quarter of pediatric RTA patients with HI in Ghana experienced unfavorable outcomes during hospitalization. Regional treatment location, greater injury severity, poly-trauma, and non-specific HI diagnoses independently predict unfavorable outcomes. These findings underscore the need to strengthen pediatric HI care through improved diagnostic capacity and early referral pathways, particularly for children with polytrauma and in the Northern Region.