Traumatic brain injury in children and adolescents: a retrospective analysis of age- and mechanism-specific injury patterns

Traumatic brain injury (TBI) is a major cause of death and long-term impairment in children and adolescents and is relevant to both clinical and forensic medicine. The aim of this study was to investigate associations between age, mechanism of injury and injury patterns in fatal pediatric TBI cases. In a retrospective observational study, 96 fatal cases in children and adolescents aged 0-18 years were analyzed over a 20-year period. A bimodal age distribution was observed, with peaks in early infancy and adolescence. Traffic accidents predominantly affected older children and were associated with complex cranial and facial fractures as well as subarachnoid and intraventricular hemorrhage (SAH, IVH). In contrast, abusive head trauma (AHT) mainly occurred in children aged two years or younger and was characterized by a higher prevalence of subdural hemorrhage (SDH) and an almost complete absence of cranial fractures. Age- and mechanism-specific injury patterns may help improve forensic evaluation in unclear cases and provide useful insights for prevention and clinical and forensic decision-making.