Exploring the causes and impact of pediatric complicated mild traumatic brain injuries

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children, with mild TBI (mTBI) accounting for approximately 80% of cases. Complicated mTBI (c-mTBI) is characterized by radiographic evidence of intracranial abnormalities and/or skull fractures. Understanding the etiology and epidemiological trends of c-mTBI in the pediatric population is crucial for prevention and management strategies. OBJECTIVE: To fill gaps in current knowledge of pediatric c-mTBI, potentially leading to improved clinical outcomes and targeted interventions. METHODS: This is a single-site, retrospective cohort study at a Level 1 Pediatric Trauma Center, reviewing the cases of pediatric patients diagnosed with a c-mTBI from 2017 to 2023. Data were extracted from the institution's trauma registry, including demographic information, injury mechanism, imaging findings, length of hospital and intensive care unit stays, and surgical intervention frequencies. Descriptive statistics were used to assess the distribution of injuries by age, gender, mechanism, and temporal factors. RESULTS: Of those meeting inclusion criteria, 761 (59.6%) were male. The mean age was 6.2 years (SD = 5.7). The highest incidence of injury was in those <3 years old. Falls were the most common cause of injury when considering all ages, but sport-related injuries and motor vehicle accidents became more predominant in those 13 years and older. Mean length of hospital stay was 2.4 days, intensive care unit stays averaged 1.5 days. A total of 78% of cases involved skull fractures and 8.5% required neurosurgical intervention. There was a higher incidence of injury during summer months and evening hours. CONCLUSION: Pediatric c-mTBI predominantly affects males and younger children, with falls as the leading cause across all age groups. As children age, sports-related injuries become more prevalent, with motor vehicle accidents contributing in adolescence. Seasonal and temporal patterns suggest targeted prevention strategies may reduce injury burden.