Prevalence of traumatic brain injury amongst children admitted to hospital in one health district: a population-based study
Introduction
Traumatic brain injury (TBI) is a major health problem and the most common cause of death or disability in childhood [1]. For children, there are no accurate figures available for the prevalence of TBI serious enough to require hospital admission. However, the British Society for Rehabilitation Medicine (BSRM) has estimated an incidence of 300 per 100,000 population for all age groups, suggesting that for young children the incidence may be up to four times higher [2]. It has also been estimated that in the UK approximately 150,000 children under 14 attend hospital every year with a TBI [3]. More recently, it has been argued that these figures are likely to be an underestimate because of inadequate recording [4].
Following a serious TBI, it is likely that there will be intellectual, academic and personality adjustment problems [5], [6], [7], [8]. Furthermore, even mild brain injuries can lead to cognitive and behavioural deficits [9], [10]. In North Staffordshire, a unique register of all children admitted with TBI has been maintained continuously since 1992 presenting an opportunity to accurately establish the incidence of TBI leading to hospital admission within a region with a relatively stable population.
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Participants and methods
Participants were all children admitted for 24 h or more to North Staffordshire Hospitals NHS Trust with a TBI. The Brain Injury Register (BIR) was maintained by a brain injury nurse who liaised with the Trauma Centre and Wards to identify all children admitted with a brain injury and to gather information on age, sex, injury cause, Glasgow Coma Scale (GCS) [11] scores (where recorded) and duration of loss of consciousness. Injury severity was established using the British Society of
Results
From 1 November 1992 to 31 December 1998, 1553 children aged 0–15 years were admitted for at least 24 h following a TBI. Two-thirds were male (999, 64.3%). The age groups most frequently admitted were 1 year olds (173, 11.1%), <1 year olds (114, 7.3%), and 7 year olds (111, 7.1%), with an average of 88.9 children in each of the other age groups (mean age=6.76, S.D.=4.6). Table 1 gives details.
Cause of injury
The causes of injury are shown in Table 2. The most frequent causes were falls (701, 45.1%), and road traffic accidents (RTAs) (328, 21.1%), often as a pedestrian (198, 12.7%). There were clear differences in the causes of injury for different age groups with more falls amongst younger children and more RTAs amongst older children. Being dropped was the cause of brain injury for 30% of babies under 1 year of age. It is possible that some of these may have been non-accidental injuries (NAIs).
Pattern of admissions
The number of admissions per year were fairly evenly spread between 1993 and 1997 with a mean of 264 per year. Table 3 gives details. 1996 saw the highest number of admissions, at 292. After 1996, the number of admissions declined, with the 1998 figure being the lowest when only 206 children were admitted. It is too early to conclude that there is a downward trend in the incidence of TBI, but it may be that recently introduced traffic calming schemes and improved road safety advice is leading
Social deprivation and traumatic brain injury
Townsend deprivation scores were calculated for the 1517 participants with valid postcodes. The lower the negative score the more prosperous an area, the higher the positive score the more deprived. The mean value was +1.12 (S.D.=2.85), compared to the national average of zero. Over two-thirds of families lived in areas with positive scores (68.2%). Using the cut-off values identified by North Staffordshire Health Authority [13], 16% of families lived in affluent areas (scores of −2.4 to −6.0),
Severity of injury
GCS scores were recorded for 745 (48%). GCS scores were frequently not recorded for younger children (405 (70.6%) of the 574 children aged under 5 years did not have a GCS score). Using GCS and/or length of unconsciousness 1284 children (82.7%) had a mild TBI, 141 (9.1%) moderate, 95 (6.1%) severe, 13 (0.8%) died, and 20 (1.3%) were of unknown severity.
The incidence of intracranial haematoma was also recorded. Of the 95 children in the severe TBI group, computed tomography (CT) scanning
Conclusions
A register of all children admitted to one health district with a TBI has been maintained continuously since 1992 which enabled us to establish the prevalence, severity, and cause of injury for children aged between 0 and 15 years. This is the first large-scale population-based study of children admitted to hospital with a brain injury to be carried out in the UK. Results showed that annually 280 children/100,000 population require hospitalisation for 24 h or more. Mild TBI accounts for 82.7% of
Acknowledgements
We thank Peter Oakley and Julia Ball of the North Staffordshire Trauma team, Deborah Collins who helped to maintain the BIR, and Jill Mullen and Laura Vroomen for entering the data onto computer. This study was partially funded by NHS Executive West Midlands under their Locally Organised Research Scheme as part of a larger study of outcomes following TBI in children.
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