Epidemiology of traumatic head injury in children and adolescents in a major trauma center in Saudi Arabia: implications for injury prevention

BACKGROUND AND OBJECTIVES: Injury to the head is the most common affected body part in pediatric trauma and could be associated with deleterious consequences. It presents a challenge for developing countries since many injuries are preventable and there are few epidemiological data to support injury prevention programs. The current study aimed to determine demographic characteristics, etiology and outcome of head injury in the pediatric population and compare findings to international figures. DESIGN AND SETINGS: Retrospective review of consecutive cases registered in major trauma center database, Riyadh, from 2001 to 2009. PATIENTS AND METHODS: The database registry was limited to hospitalized patients following injury. Any head injury in a patient <= 18 years was included. RESULTS: Of 3796 patients identified, 1219 patients (32.1%) suffered head injury (mean age 8.6 years; males 78.4%). Children under 12 years comprised 66.3%. Motor vehicle crash (MVC) was the commonest cause (34.2%), followed by pedestrian injury (30.3%) and falls (28.4%). When stratified by age, falls (45.6%) were the most common etiology under 6 years while MVC was the leading cause in high school students (74.4%). The latter group had the lowest mean (SD) Glascow coma scale scores (8.58 [4.7]), highest mean injury severity scale scores (23.4 [21]), highest rate of craniotomy (7%) and highest mortality (20%). CONCLUSION: One third of pediatric trauma requiring hospital admission suffered head injury. Preschoolers and elementary school students were mostly affected. The striking incidence of pedestrian and fall injuries call for organized national prevention programs. Additionally, more attention should be directed to reduce MVC among high school students given their comparative high rate of severe injuries and deaths following trauma.