CHARACTERISTICS AND OUTCOMES OF PAEDIATRIC TRAUMATIC BRAIN INJURIES PRESENTING TO KOMFO ANOKYE TEACHING HOSPITAL.

Abstract

Introduction: Traumatic Brain Injury (TBI) in children is a major cause of morbidity and mortality in many countries. Despite the magnitude of this problem in children, there are limited studies to characterise paediatric TBI in Ghana. The primary objective of this study was to determine the characteristics and outcomes of children less than 15 years presenting to a tertiary academic teaching hospital with acute traumatic brain injury at discharge and three months post-injury. The secondary objective was to identify the factors which accounted for the variation in the outcomes of children presenting with TBI. Methods: This was a hybrid study consisting of a prospective cross-sectional study of consecutive children, less than 15 years of age, who presented with TBI to the Komfo Anokye Teaching Hospital Emergency Department (KATH ED): in addition, an embedded cohort study was performed which followed up for three months those patients discharged from the hospital. Socio-demographic and injury characteristics were collected. Participants were followed until hospital discharge. Mortality as an outcome at hospital disposition was determined. Another outcome, the Paediatric Glasgow Outcome Scale- Extended (GOSE), was assessed within 24 hours of discharge and repeated at three months post-TBI. Research Electronic Data Capture (REDCap) was used to enter the data into a secured database electronically. Data was exported to Microsoft Excel ® for data cleaning, after which STATA 13.1 was used for the analysis. Results: A total of 369 patients presented with paediatric trauma to the KATH ED during the study. 136 of these children were managed for traumatic brain injury (TBI) giving a prevalence of 36.86%. Males predominated (63.24%) with the 5- to 9-year age group mostly (41.91%) affected. Road traffic crashes (69.12%) with pedestrian-vehicle collision (67.02%, 63/94) were the most frequent mechanisms of paediatric TBI. The majority (94.12%) of the children with TBI were managed conservatively with a neurosurgical operative rate of 1%. Paediatric TBI mortality rate was 10.29%. Most (61.98%, 75/121) were discharged with a moderate-to-severe disability according to the paediatric GOSE. At three months post-TBI, the majority (91.18%, 93/102) of the discharged patients had a good recovery from the TBI. Severe TBI (adjusted OR [AOR] 136.02, 95% CI 2.76 to 6,706.22) and the development of

complication on the ward (AOR 29.03, 95% CI 2.44 to 344.91) were independent positive predictors of mortality for children with TBI, whereas anti- seizure requirement was less likely to predict a good recovery at 3 months post- TBI (AOR, 0.15; 95% CI, 0.03 to 0.72). Interpretation: A significant number of children with TBI were discharged with an acquired disability; however, by three months post-TBI, most of the children had made a good recovery. For many children with TBI, conservative management may be sufficient as the definitive management plan. Conclusions: Paediatric TBI was common affecting 1 in 3 children presenting with paediatric trauma to KATH ED. It mainly affected males, those aged between 5 and 9 years, with RTCs being the principal mechanism of injury. Although most children with TBI were discharged with moderate-to-severe disability from the TBI, three months following the injury, most of them had recovered adequately. Successful long-term follow-up of paediatric trauma, and specifically paediatric TBI, is feasible in LMICs such as Ghana. The paediatric TBI care in Ghana could inform such care in High-Income Countries.