Management and outcomes of pediatric traumatic brain injury in Nigeria: a systematic review

Abstract

Objective: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality globally, with children in low- and middle-income countries (LMICs) contributing a sizable share. In Nigeria, where there is a large unmet need for neurosurgical interventions for pediatric TBI (pTBI), the mortality rate is reportedly higher than those of their LMIC and high-income counterparts. Thus, a comprehensive, national review of pTBI management and outcomes is needed. This study's objective was to comprehensively investigate the demographics, etiology, management, outcomes, and mortality of pTBI in Nigeria between 1962 and 2023.

Methods: A systematic literature search was conducted of the PubMed, Global Index Medicus, Embase, Scopus, African Journals Online, Web of Science, and Google Scholar databases. Variables included TBI etiology, patient presentation, trauma duration before in-hospital presentation, clinical severity, treatment, outcomes, mortality, and the follow-up period, when available. Temporal trends in the pTBI literature were divided into two epochs, pre-2015 and post-2015, based on the Lancet Commission on Global Surgery report that highlighted improvements needed in surgical care, especially in LMICs.

Results: After the elimination of duplicates and two independent screenings, 30 studies encompassing 2234 pediatric patients were included for data extraction. All studies were published between 1971 and 2023. The mean patient age was 7.2 (SD 4.7) years and 65.4% of the patients were male. The most common presentations were loss of consciousness (n = 441, 25.8%) and seizures (n = 234, 13.7%), and the most common etiologies were road traffic accidents (n = 903, 52.2%) and falls from height (n = 560, 32.4%). Most cases were classified as mild TBI (n = 783, 36.7%), and their share increased progressively over the time periods. Most patients received nonoperative management (n = 399, 60.1%). For those who underwent operative management, the most common procedure was a craniectomy or craniotomy (n = 99, 37.4%). Seizure disorder was the most common neurological complication. The overall weighted mortality rate was 10.2%, which remained relatively stable over the two time periods.

Conclusions: This study elucidates important characteristics of pTBI patients in Nigeria and how these characteristics have changed over time. While incomplete and missing data remain a limitation, this study highlights an overall decrease in severe pTBI burden over time, with a reduction of cases attributable to road traffic accidents.

Keywords: Nigeria; global surgery; neurosurgery; pediatric TBI; systematic review; trauma; traumatic brain injury.