Global Epidemiology of Pediatric Traumatic Brain Injury: Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is a public health concern that leads to premature deaths and disability in a large number of children worldwide. The aim of this study was to estimate the global incidence of pediatric TBI and to compare the clinical presentation and outcome of pediatric TBI in different countries, regions, and income settings. METHODS: A systematic review was conducted to identify studies on pediatric patients with TBI published from 2000 onward. Studies that contained population-level data were included in meta-analyses to calculate the incidence of TBI and TBI-related mortality. Studies that reported hospital-level data were pooled to calculate mortality rates, proportion of patients with severe TBI, and proportion of TBI resulting from falls and road traffic injuries. RESULTS: The estimated global incidence of pediatric TBI was 226.4 per 100 000 children annually, using data from 25 studies in 5 regions. An estimated 1.9 per 100 000 children die from TBI each year. Based on 79 studies from 42 countries, 11.0% (median: 10.7%) of patients had severe TBI. The overall mortality rate was 1.4% (median: 3.2%). In 28 studies, the median mortality rate for severe TBI was 26.7%. Studies from low-income and middle-income countries reported higher proportions of patients with severe TBI and higher mortality rates. Road traffic injuries were the most common cause of TBI among children in Africa and in low-income countries. Falls were more common in other regions. CONCLUSION: Every year, about 5.4 million children worldwide sustain a TBI. Disparities in the estimated incidence rates of pediatric TBI among countries may represent true differences in frequency or variability in the capacity of health systems to address TBI. Population-level data remain lacking in low-income and lower-middle–income countries.