Epidemiology, Clinical Profiling, Management, and Functional Outcome in Moderate-to-Severe Traumatic Brain Injury in Children: A Single-center Experience

BACKGROUND: Pediatric traumatic brain injury (TBI) is a leading cause of morbidity and mortality, with children being more vulnerable due to thinner skulls, immature autoregulation, and lower seizure thresholds. In India, they account for up to 30% of TBI cases. The outcomes remain variable, especially in the low-resource settings, highlighting the need to understand local epidemiology and management strategies. MATERIALS AND METHODS: A prospective study of 70 children aged 1-14 years admitted with moderate-to-severe TBI at a tertiary neurosurgical center between August 2023 and February 2025. Data on demographics, mechanism of injury, clinical and radiological findings, management, and outcomes (Glasgow Outcome Scale [GOS]) at 3 and 6 months were recorded. RESULTS: Most patients were 1-7 years old (71.4%) and male (58%). Falls from height (42.9%) were the leading cause, followed by road traffic accidents (32.9%) and assault (17.1%). Vomiting (55.7%) and headache (44.3%) were the most common presenting symptoms. Skull fractures (51.4%) and subdural hematomas (37.1%) predominated on computed tomography scans. Conservative management was employed in 64.3%, surgery in 35.7%. GCS improved significantly from admission to discharge (P < 0.001). At 6 months, 49 of 70 children achieved GOS 4 or 5, with overall mortality of 14.3. CONCLUSION: Pediatric TBI is a significant health burden, with falls as the leading cause; early intervention and preventive measures, including home and road safety, are essential to improve the outcomes.