Characterization and Prognostic Factors of Severe Pediatric Traumatic Brain Injury

INTRODUCTION: Trauma is the leading cause of death and disability among children and young adults. In particular, traumatic brain injury (TBI) stands out as the main cause of mortality and morbidity associated with pediatric trauma. It has a high likelihood of neurological, structural, functional, and behavioral sequelae among survivors, remaining a significant public health issue with notable impact on society. This study aimed to characterize patients with the diagnosis of severe TBI in a Pediatric Intensive Care Unit (PICU) over the past 15 years and to explore prognostic factors associated with mortality at PICU discharge. MATERIALS AND METHODS: This was an exploratory observational study using a retrospective data collection method, conducted in the PICU of a Portuguese tertiary-level pediatric hospital. All children admitted with severe TBI between January 2010 and December 2024 were included. Demographic, clinical, and laboratory data were collected. Mortality at PICU discharge was the primary outcome analysed. RESULTS: Ninety-seven children with severe TBI were included (1.6% of all admissions). The main trauma mechanisms were pedestrian accidents and motor vehicle collisions. Overall mortality was 21.6%. In exploratory multivariable analysis, Pediatric Index of Mortality 3 (PIM3) was the only variable significantly associated with mortality. In univariable analysis, arterial hypotension and intracranial hypertension were associated with mortality. In parallel, early clinical and laboratory variables demonstrated relevant discriminatory ability in ROC analyses, and data-derived thresholds associated with mortality were identified for initial Glasgow Coma Scale (GCS) (≤4), PIM3 (>64.3), lactate (>4 mmol/L), and fibrinogen (