Patterns And Factors Associated With Early Outcomes In Paediatric Traumatic Brain Injury At Mulago National Referral Hospital An Observation Cross-Sectional Study

Abstract

Background: Childhood injuries account for 5.4 percent of all childhood deaths worldwide each year. Traumatic Brain Injury (TBI) is the commonest cause of injury among children. A study done in Western Uganda looked at the in-hospital mortality and discharge GCS. However, no study has been done in Uganda to look at the 6-month outcome among children with TBI. This study will describe the patterns and identify the factors associated with early outcomes in paediatric traumatic brain injury at Mulago National Referral Hospital. Methods: We retrieved treatment files for all children aged 0-14 years admitted with TBI at Mulago hospital in 2021. We extracted data on age, sex, residence, mechanism and nature of injury, severity of head injury, type of cranial injury, extracranial injury, management and blood tests. We used modified Poisson regression to identify factors associated with death during admission and 6-month recovery. Ordered logistic regression was used to identify factors associated with the PTSD at 6-months. Results: We identified 266 children. Of these, 189(71%) were males, 84(32%) had severe head injury, the median age was 10 years [IQR] 5–13 years and 33 (12%) died. Of the deaths, 24(73%) were males and 30(91%) had severe head injury. Having intracranial hemorrhage 2.424(1.143- 5.139) increased the risk of death while having moderate head injury 0.207(0.067-0.636), and having limb injury 0.319(0.173-0.589) decreased the risk. Of the 233 children who were discharge alive, 138(70%) were males, 54(23%) had severe head injury. After 6-months, having spinal injury 2.24(1.041-4.803) increased the risk of poor recovery while severity of head injury 0.046(0.0044-0.475) decreased the risk. For PTSD, pediatric TBI with severe PTSD were 0.254% and 0.002% more likely to suffer an abdominal or spinal injury, respectively. For PT- INR, the probabilities of moderate and severe PTSD against mild PTSD are 0.175 times greater, assuming all other model factors remain equal. The same is true for mild and moderate PTSD over no PTSD. The study found a strong association between injury severity and PTSD  in  children; moderate TBI increases the log odds of severe PTS by 5.130. Class 1 of the Marshall injury classification was associated with severe PTSD 21.5% more than other classes. Conclusion: Severity of head injury, extracranial injuries specifically spinal injury was associated with poor outcomes. Intracerebral haemorrhage, hypoglycaemia were independent predictors of in-hospital death, GCS on discharge, and anaemia for poor 6-month recovery and PT-INR and Marshall injury classification, class 1, predict PTSD.