Characteristics of traumatic brain injury in children and adolescents hospitalized in a Brazilian trauma reference center: a retrospective cross-sectional study

Abstract

Background Approximately 20% of victims of traumatic brain injury (TBI) in Brazil are children and adolescents, with more than 900 deaths per year.

Objective To describe the characteristics and epidemiological profile of children and adolescents with TBI in the city of São Paulo, Brazil, according to age groups and metropolitan area of occurrence of the events leading to trauma.

Methods We conducted a retrospective cross-sectional study with a review of consecutive medical records of children and adolescents with TBI hospitalized and treated at a level-1 trauma center in São Paulo between 2019 and 2023.

Results In the period proposed for the study, 196 children and adolescents suffered TBIs. They had a median age of 5 (interquartile range [IQR] 10–1.75) years and were predominantly boys (71%), of white skin color/race (55%), and coming from the north zone of the metropolitan region of São Paulo (44%). Domestic accidents were the main causes of TBI (61%), followed by traffic accidents (24%). The mean length of hospital stay was of 13 (standard deviation [SD] ± 26) days, and the in-hospital mortality rate was of 3%.

Conclusion We found a predominance of children and adolescents with TBI coming from the north zone of the metropolitan region of São Paulo, with a prevalence of falls from heights above the ground among children ≤ 9 years of age and trampling among children older than this age. Preventive actions must be established after reflections on socioeconomic issues and considering the metropolitan area where the accidents occur and the age group.

Keywords

Craniocerebral Trauma - Glasgow Coma Scale - Brain Injuries - Wounds and Injuries

Authors' Contributions

Conceptualization: JRTM; Methodology: JRTM; Data collection: JRTM, CVAC, CK, MACF, RH; Formal analysis and investigation: JRTM; Writing-original draft preparation: JRTM; Writing-review and editing: JRTM, CVAC, CK, MACF, RH, JGO, JCEV; Funding acquisition: JRTM, CVAC, CK, MACF, RH, JGO, JCEV; Supervision: JCEV.

Data Availability Statement

The database is located in the Neurosurgery Division of the Department of Surgery, Santa Casa of São Paulo, Hospital and School of Medical Sciences, Brazil. Further inquiries can be directed to the email of the corresponding author: [e-mail] or [e-mail].

Editor-in-Chief: Ayrton Roberto Massaro.

Associate Editor: Gisele Sampaio Silva.

Publikationsverlauf

Eingereicht: 15. August 2024

Angenommen: 30. Dezember 2024

Artikel online veröffentlicht:
22. April 2025

• References

• 1 de Souza LC, Mazzu-Nascimento T, de Almeida Ballestero JG, de Oliveira RS, Ballestero M. Epidemiological study of paediatric traumatic brain injury in Brazil. World Neurosurg X 2023; 19: 100206
• 2 Andrade AF, Maset AL, Valêncio CR. et al. First Brasilian cooperative study on neurotraumatology. Preliminary reports. Braz Neurosurg 2005; 24 (04) 133-143
• 3 Chaitanya K, Addanki A, Karambelkar R, Ranjan R. Traumatic brain injury in Indian children. Childs Nerv Syst 2018; 34 (06) 1119-1123
• 4 Rabiu TB, Ogundipe H. Profile of pediatric brain injury in south-west Nigeria. World Neurosurg 2022; 166: e711-e720
• 5 Melo JRT, Silva RA, Moreira Jr ED. [Characteristics of patients with head injury at Salvador City (Bahia–Brazil)]. Arq Neuropsiquiatr 2004; 62 (3A) 711-714
• 6 Melo JRT, de Santana DLP, Pereira JLB, Ribeiro TF. [Traumatic brain injury in children and adolescents at Salvador City, Bahia, Brazil]. Arq Neuropsiquiatr 2006; 64 (04) 994-996
• 7 Kelly KA, Patel PD, Salwi S, Iii HNL, Naftel R. Socioeconomic health disparities in pediatric traumatic brain injury on a national level. J Neurosurg Pediatr 2021; 29 (03) 335-341
• 8 Melo JRT, Di Rocco F, Lemos-Júnior LP. et al. Defenestration in children younger than 6 years old: mortality predictors in severe head trauma. Childs Nerv Syst 2009; 25 (09) 1077-1083
• 9 Du RY, LoPresti MA, García RM, Lam S. Primary prevention of road traffic accident-related traumatic brain injuries in younger populations: a systematic review of helmet legislation. J Neurosurg Pediatr 2020; 25 (04) 361-374
• 10 Brazilian Institute of Geography and Statistics - IBGE. (2023). In: Cities and States demographic census. http://www.ibge.gov.br . Accessed November 12, 2023
• 11 Secretaria de Saúde do Estado de São Paulo. (2024) In: Hospitais de referência da rede publica de saúde. https://www.saude.sp.gov.br/ses/sites-de-interesse/hospitais . Accessed January 5, 2024
• 12 Map of Social Inequality. (2023). https://institutocidadessustentaveis.shinyapps.io/mapadesigualdadesaopaulo . Accessed January 3, 2024
• 13 Secretaria de Estado da Saúde de São Paulo. (2024) In: Regulação da Urgência e Emergência RRAS 6 São Paulo. https://www.saude.sp.gov.br/ses/perfil/gestor/homepage/destaques/regulacao-da-urgencia-e-emergencia-rras-6-sao-paulo . Accessed Dez 9, 2024
• 14 Barbosa DVS, Barbosa NB, Najberg E. Health regulation: challenges to the Unified Health System governance. Cad Saude Colet 2016; 24 (01) 49-54
• 15 Melo JRT, de Brito Tischer CM, Rodrigues FPA. et al. Accuracy of acute hyperglycemia as a biomarker of severe brain damage in children with traumatic brain injury. Childs Nerv Syst 2024; 40 (09) 2781-2787
• 16 Melo JRT, Di Rocco F, Blanot S. et al. Mortality in children with severe head trauma: predictive factors and proposal for a new predictive scale. Neurosurg 2010; 67: 1542-1547
• 17 Brazilian Institute of Geography and Statistics – IBGE. (2023) In: Desigualdades sociais por cor ou raça no Brasil. https://educa.ibge.gov.br/jovens/materias-especiais/21039-desigualdades-sociais-por-cor-ou-raca-no-brasil . Accesssed January 3, 2024
• 18 Dutenkefer E. Methods and methodologies to unveil the accessibility of the city of São Paulo. Revue franco-brésilienne de géographie 2016; https://doi.org/10.4000/confins.11116 . Accessed November 28, 2023
• 19 Fabbri A, Servadei F, Marchesini G, Stein SC, Vandelli A. Early predictors of unfavourable outcome in subjects with moderate head injury in the emergency department. J Neurol Neurosurg Psychiatry 2008; 79 (05) 567-573
• 20 Settervall CHC, de Sousa RMC, Fürbringer e Silva SC. In-hospital mortality and the Glasgow Coma Scale in the first 72 hours after traumatic brain injury. Rev Lat Am Enfermagem 2011; 19 (06) 1337-1343
• 21 Chiaretti A, De Benedictis R, Langer A. et al. Prognostic implications of hyperglycaemia in paediatric head injury. Childs Nerv Syst 1998; 14 (09) 455-459
• 22 Nascimento ACO. The influence of patriarchal ideology in defining children's toys. Rev Fac Serv Soc UFRJ 2016; 37: 296-318
• 23 Collins NC, Molcho M, Carney P. et al. Are boys and girls that different? An analysis of traumatic brain injury in children. Emerg Med J 2013; 30 (08) 675-678
• 24 Muzyka L, Garza HH, Merheb D, Sanchez J, Tyler-Kabara E, Lawson KA. Traumatic head injuries from ceiling fans at a pediatric level I trauma center in the United States. Pediatr Neurosurg 2024; 59 (01) 14-19
• 25 Silva JAV, Padula MPC, Waters C. Epidemiological and clinical profile and outcome of patients with traumatic brain injury. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo 2021; 66: e017
• 26 Rudelli BA, Silva MV, Akkari M, Santili C. Accidents due to falls from roof slabs. Sao Paulo Med J 2013; 131 (03) 153-157
• 27 Babu A, Rattan A, Ranjan P. et al. Are falls more common than road traffic accidents in pediatric trauma? Experience from a Level 1 trauma centre in New Delhi, India. Chin J Traumatol 2016; 19 (02) 75-78
• 28 Cucinotta D, Vanelli M. WHO declares COVID-19 a Pandemic. Acta Biomed 2020; 91 (01) 157-160
• 29 Wise J. Covid-19: WHO declares end of global health emergency. BMJ 2023; 381: 1041
• 30 Keays G, Friedman D, Gagnon I. Injuries in the time of COVID-19. Health Promot Chronic Dis Prev Can 2020; 40 (11-12): 336-341
• 31 Kuppermann N, Holmes JF, Dayan PS. et al; Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009; 374 (9696): 1160-1170
• 32 Kochanek PM, Tasker RC, Carney N. et al. Guidelines for the management of pediatric severe traumatic brain injury: update of the brain trauma foundation guidelines. Pediatr Crit Care Med 2019; 20 (3S, Suppl 1) S1-S82
• 33 Godoy DA, Rubiano AM, Aguilera S. et al; Latin America Brain Injury Consortium Consensus. Moderate traumatic brain injury in adult population: the Latin American Brain Injury Consortium Consensus for definition and categorization. Neurosurgery 2024; 95 (03) e57-e70
• 34 Yang C, Ma Y, Xie L. et al. Intracranial pressure monitoring in the intensive care unit for patients with severe traumatic brain injury: analysis of the CENTER-TBI China Registry. Neurocrit Care 2022; 37 (01) 160-171
• 35 Magalhães ALG, Barros JLVM, Cardoso MGF. et al. Traumatic brain injury in Brazil: an epidemiological study and systematic review of the literature. Arq Neuropsiquiatr 2022; 80 (04) 410-423
• 36 Ducrocq SC, Meyer PG, Orliaguet GA. et al. Epidemiology and early predictive factors of mortality and outcome in children with traumatic severe brain injury: experience of a French pediatric trauma center. Pediatr Crit Care Med 2006; 7 (05) 461-467
• 37 Verchère J, Blanot S, Vergnaud E, Vecchione A, Zerah M, Meyer PG. Mortality in severe traumatic brain injury. Lancet Neurol 2013; 12 (05) 426-427
• 38 Municipal Human Development Index - IDHM. (2015). https://dados.prefeitura.sp.gov.br/es/dataset/indice-de-desenvolvimento-humano-municipal . Accessed October 4, 2024.