Incidence Rates for Traumatic Brain Injury in Children

 

Authors: 


Audrey McKinlay

School of Psychology and Psychiatry, Monash University, Melbourne Australia


Carol Hawley

School of Psychology, Univeristy of Warwick, UK

 

Introduction:

Traumatic brain injury (TBI) is a leading source of childhood injury, with the Centre for Disease Control (CDC) stating that in the USA alone, almost half a million (473,947) emergency department (ED also referred to as accident and emergency departments)visits for TBI are made annually by children aged 0 to 14 years.1 While most of these will be classified as mild, even this level of injury is associated with ongoing problems.2 Further, the numbers of children affected not only make TBI a major health issue, but also represent a significant financial burden, with charges for these hospital visits estimated at around 1 billion dollars per year in the USA.3 It is also important to note that children affected by TBI are likely to require extensive intervention and educational support to enable them to achieve optimal recovery. Therefore, an accurate understanding of the numbers of children affected by TBI is essential for the planning of health care and recovery management.

It is difficult to be definitive about the rates of TBI in children as these vary depending on which data is used; e.g. ED attendance, hospital admissions and general practitioner visits, death, and the inclusion of older age groups (in some cases up to age 17), as well as variations in how TBI is defined. A recent review of incidence rates for all age ranges, reported lowest rates for U.S (103/100,000) and highest rates for Asia (344/100,000), with 23 European countries reporting an average incidence rate of approximately 235/100,000.4 However, these data were not specific to children. Table 1 shows research that has been published over the last 10 years where rates of TBI for children can be extracted, as can be seen, rates vary from 280-1,373/100,000. Lowest rates are evident for studies where hospital admissions only are used, and highest rates where hospital admissions, hospital presentations and GP visits are used. Despite differences in reported rates of TBI in children, due to variations in case inclusion, there are also areas of agreement, offering potential sources of focus for intervention strategies.

Mode of Injury

As shown in Table 1, the most frequent cause of injury is blunt trauma, with penetrating injury being much less common and accounting for only a small percentage of all childhood TBI events. For children under 14 years of age, falls and road traffic accidents are by far the most common sources of injury, regardless of geographic location. However, mode of injury varies with age, with falls being particularly prevalent among children under 4 years, and motor vehicle accidents being more likely for older children (see Table 1). The predominance of falls and motor vehicle accidents as primary modes of injury for children is one of the most consistent findings in the recent literature with Kraus, for example, reporting a similar finding in 1995.5


Predictors of TBI

In almost all age groups males outnumber females in terms of number and severity of injury. This trend for increased incidence of TBI for males may be due to a number of factors including higher engagement in risk taking activities, more hours of exposure to high-risk activities and reduced supervision for male children.6-9 Incidence rates also vary with age, with most studies reporting higher rates for those under 5 and those in the adolescent years.6-11 Recent research also reports that incidences rates differ depending on race, with blacks being more likely to experience TBI than non blacks.9

Social deprivation has not been found to be a significant predictor of TBI events. Hawley et al. 5 examined sources of injury based on social deprivation and found only a slight increase in road traffic accidents for those from disadvantaged areas.6 However, those from advantaged areas were more likely to be injured in assaults.6 Other factors may increase risk; McKinlay et al.11 found that children with parents with higher levels of stress and who were younger at the time of the child’s birth, were more likely to experience a TBI event.


Severity of Injury

The majority of injuries among children are classified as mild (between 80- 90%),6, 12 and if hospitalised time in hospital is usually brief.8 However, a significant number of children experience moderate – severe injuries. More severe injuries are generally associated with road traffic accidents. This seems a bit brief. You could add in something about severity and outcome?


Time of Day and Year

Not surprisingly, injuries have been reported as more prevalent during the warmer months and less prevalent during the colder months.6, 13 This is likely due to the fact that children usually spend more time outdoors during the warmer months, and are thus more difficult to supervise, thereby increasing the opportunity for activities that may result in injury. Injury rates have also been reported as varying depending on the day of the week, with slightly higher rates on Fridays and Saturdays, once school is out.13

In conclusion, it is clear that TBI is an important cause of injury for children, with fall related injuries being particularly common for preschoolers. Rates of injury differ with age and demographic area. Much of the discrepancy between regions will be due to differences in case inclusion. Children may be more at risk depending on level of social disadvantage and reduced social opportunity. Higher rates of injury are found when children are more able to engage in outdoor activity and when parental supervision is lower. It is important that a consistent method of medical recording is developed to ensure that more accurate rates for this injury type are collected. Accurate incidence information is essential for the planning of treatment and rehabilitation services.


References

Centers for Disease Control and Prevention (2013). How many people have TBI? In: http://www.cdc.gov/traumaticbraininjury/statistics.html. National Center for Injury control and Prevention.

McKinlay, A. (2010). A review of outcomes associated with mild traumatic brain injury for children and adolescents. . Child Care Health Care and Development 36, 3-21.

Prevention, C.f.D.C.a. (2013). How many people have TBI?

Tagliaferri, F., Compagnone, C., Korsic, M., Servadei, E. and Kraus, J.F. (2006). A systematic review of brain injury epidemiology in Europe. Acta Neurochirugica148, 255-268.

Kraus, J.F. (1995). Epidemiological features of brain injury in children: Occurrence, children at risk, causes and manner of injury, severity and outcomes. Oxford University Press: New York.

Hawley, C.A., Ward, A.B., Long, J., Owen, D.W. and Magnay, A.R. (2003). Prevalence of traumatic brain injury amongst children admitted to hospital in one health district: a population-based study. Injury, Int, J. Care Injured34, 256-260.

McKinlay, A., Grace, R.C., Horwood, L.J., Fergusson, D.M., Ridder, E.M. and MacFarlane, M.R. (2008). Prevalence of traumatic brain injury among children, adolescents and young adults: Prospective evidence from a birth cohort. Brain Injury22, 175-181.

Koepsell, T.D., Rivara, F.P., Vavilala, M.S., Wang, J., Temkin, N., Jaffe, K.M. and Durbin, D.R. (2001). Incidence and descriptive epidemioligic features of traumatic brain injury in King County, Washington. Pediatrics128, 946-954.

Langlois, J.A., Rutland-Brown, W. and Thomas, K.E. (2005). the incidence of traumatic brain injury among children in the United States: Differences by race. Journal of Head Trauma Rehabil, 229-238.

Wu, X., Hu, J., Zhuo, L., Fu, c., Hui, G., Wang, Y., Yang, W., Teng, L., Lu, S. and Xu, G. (2004). Epidemiology of traumatic brain injury in Eastern China, 2004: A prospective large case study. Journal of Trauma, Injury, Infection, and Critical Care.64, 1313-1319.

Kim, H.B., Kim, D.K., Kwak, Y.H., Shin, S.D., Song, K.J., Lee, S.C., Park, J.O., Jang, H.Y. and Kim, S.C. (2012). Epidemiology of traumatic head injury in korean children. Emercency and Critial Care Medicine27, 437-442.

McKinlay, A., Grace, R., Horwood, L., Fergusson, D., Ridder, E. and MacFarlane, M. (2008). Prevalence of traumatic brain injury among children, adolescents and young adults: prospective evidence from a birth cohort. Brain Injury22, 175-181.

Koepsell, T.D., Rivara, F.P., Vavilala, M.S., Wang, J., Temkin, N., Jaffe, K.M. and Durbin, D.R. (2011). Incidence and descriptive epidemioligic features of traumatic brain injury in King County, Washington. Pediatrics128, 946-954.

Styrke, J., Stalnacke, B., Sojka, P. and Bjorstig (2007). Traumatic brain injuries in a well-defined population: epidemiological aspects and severity. Journal of  Neurotrauma24, 1425-1436.

 

 

 

Table 1: Selected published rates for traumatic brain injury in children (2003 to 2013).

Author

Country

Method

Age range

Mode

Most frequent

Epidemiology

Hawley eta al (2003)6

 

UK

All children admitted for 24hours or more to North Staffordshire Hospitals with TBI.

0-15 yr

Falls

280/100,000

Highest rate for 0-4yr

Kim et al (2012)11

Korea

A prospective study of children who attended Emergency Department of 5 hospitals

0-18yr

Collisions

Falls

Motor vehicle

32% of all emergency department admissions

Koepsellet al (2011)13

United States

Stratified random sample of hospital emergency departments in the King Country Washington (2007-2008).

0-17yr

Falls for under 5s

Struck by object 5-14

304/100,000

Highest risk 0-4yr 482/100,000

Langlois, et al (2005)9

USA

Unintentional injuries -based on data from the National Centre for Health Statistics using TBI related deaths, hospitalizations and Emergency Department visits. (years 1995-2001).

0-14 yr

 

798/100,000 -0-14yr

Highest rate for 0-4 yr 1120/100,000

McKinlay et al (2008)7

New Zealand

All confirmed TBI events in a longitudinal birth cohort (GP, Hospital ED, Hospital admissions and deaths).

0-15 yr

Falls

1,373/100,000

Highest rate for 0-5yr 1475/100,000

Styrke et al

(2007)14

Sweden

All inpatient and outpatient  presentations at hospital during 2001

0-14yr

Falls

Approximately Highest rate for 10-14 yr

Schneier, et al 2006

US

Retrospective analysis of inpatient data. Rates are for hospitalisation rates only.

0-17

Not specified

70/100,000 hospitalisation rates

Highest rate for 15-17yr

Wu et al (2004)10

China

Multicentre trial in eastern China. Data collected from 77 hospitals by standardized structured questionnaires. Hospital admissions.

0-14 yr

Not specified for children

Traffic accidents, knock to head and falls leading case for all ages combined

6.8% of injuries occurred for those 0-14 years. No increased risk for 0-4

 

 

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