Paediatric traumatic brain injury: clinical presentation, treatment approaches, management strategies, and outcomes. Insights from the CENTER-TBI study

Abstract

Objective: This observational study aims to describe the characteristics and management of paediatric head-injured patients across different paediatric age groups, compared with adults.

Design: Secondary analysis of the CENTER-TBI study.

Setting: 65 centers in Europe between December 2014 and December 2017.

Patients: Patients with traumatic brain injury (TBI) admitted to the hospital were divided into different age groups: paediatrics (pTBI, age ≤ 17 years), adults (18-65 years), and elderly (> 65 years). Paediatrics were further subdivided into three groups: toddlers (from 0 to 4 years), children (from 5 to 12 years), and adolescents (from 13 to 17 years).

Interventions: None.

Measurements and main results: 3,661 patients were included in the analysis (2,138 admitted to the intensive care unit (ICU) and 1,523 to the ward). Among these, 227 were paediatric (27 toddlers [0-4 years], 65 children [5-12 years], and 135 adolescents [13-17 years]). Most pTBI patients admitted to the ICU presented with mild injuries (Glasgow Coma Scale [GCS] 13-15; 66%), although severe injuries (GCS ≤ 8) were more common in adolescents (23.8%). Susceptibility to neuroworsening and seizures was low in the paediatric group (6% and 3.5%, respectively). Intracranial pressure monitoring was performed in 52 (39.4%) of 132 paediatric ICU patients. Paediatric patients received less intensive therapy targeted to the intracranial pressure (ICP) control particularly in toddlers. Age below 18 years was associated with a lower risk of poor neurological outcomes at six months, particularly in adolescents and children (odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.15-0.58 p < 0.001 and OR = 0.29, 95% CI = 0.09-0.71, p < 0.001, respectively). In toddlers, the association was not statistically significant (OR = 0.48, 95% CI = 0.07-1.94, p = 0.4).

Conclusions: Paediatric TBI differs significantly from non-paediatric cases, with predominantly mild injuries, lower neuroworsening rates, and less intensive management, especially in younger children. Outcomes at six months are generally more favorable in paediatric patients, emphasizing the need for age-specific management strategies in TBI care.

Keywords: Intensive care unit; Neurocritical care; Paediatric; Traumatic brain injury.

Fig. 1

Therapy intensity levels (TIL) stratified by paediatric age groups. Stacked bar plot illustrating the distribution of specific therapeutic interventions used for ICP management across paediatric subgroups (toddlers, children, adolescents). Lower-intensity measures (Tier 1) were more frequently applied in younger children, while higher TIL scores were observed predominantly in adolescents. Abbreviations: TIL = Therapy Intensity Level; CSF = Cerebrospinal fluid drainage; CPP = Cerebral perfusion pressure

Fig. 2

Multivariable logistic regression model for unfavorable outcome (GOS-E ≤ 4) at 6 months. Odds ratios with 95% confidence intervals are shown for relevant predictors of poor functional outcome. Age below 18 years was associated with a lower odds of unfavorable outcome, especially in children and adolescents. Abbreviations: GOS-E = Glasgow Outcome Scale – Extended; GCS_m = Glasgow Coma Scale motor; ICU = Intensive Care Unit