Paediatric CT-positive traumatic brain injury admitted to a tertiary neurotrauma centre: trends in epidemiology and surgical interventions

Approximately 5.4 million children sustain traumatic brain injury (TBI) annually worldwide. Children with cranial CT-positive findings often require admission to a neurotrauma centre (NTC); however, the incidence of such admissions and the subsequent need for intracranial surgery remain incompletely characterised. We conducted a retrospective cohort study based on prospectively collected data of children < 18 years with CT-positive TBI admitted to the NTC in Oslo, Norway. Incidence rates were calculated using population data from the NTC catchment area and stratified by age group to account for differences in physiology and behaviour. Clinical and radiological severity, injury mechanisms, and seasonal trends were analysed. The incidence rates of CT-positive paediatric TBI and subsequent intracranial surgery admitted to the NTC were 7.87 and 2.08 per 100,000 person-years, respectively. Males had higher incidence rates than females for CT-positive TBI (IRR 1.80) and intracranial surgery (IRR 1.64). Clinical severity according to the Head Injury Severity Scale decreased over time (OR 0.92 per year, 95% CI 0.87–0.98; p = 0.008), whereas radiological severity by the Rotterdam CT score remained stable. Injury mechanisms differed significantly by age group ( p < 0.001), with falls predominating in younger children and road traffic-related injuries, including bicycle and e-scooter incidents, in adolescents. E-scooter-related TBIs emerged as a new entity after the introduction in 2019. No seasonal variation in the risk of surgery was observed. Incidence rates of CT-positive TBI and intracranial surgery remained stable over the 10-year period. Clinical severity declined, whereas radiological severity was stable. E-scooters emerged as an new injury mechanism among adolescents after 2019.