72 Incidence and Outcome of Inflicted Traumatic Brain Injury at the Paediatric Intensive Care Units in the Netherlands

Abstract

Background Inflicted traumatic brain injury (iTBI) is recognized as a major cause of death and poor outcome in young children. Aim To determine the incidence and outcome of children with iTBI at the Paediatric Intensive Care Units (PICUs) in the Netherlands. Methods The Dutch PICU registry was used to identify all children (0-2 years) who were admitted with traumatic brain injury (TBI) between 1-1-2005 and 31-12-2009. ITBI was defined as (1) proven with a confession or conviction, (2)confirmed by the Child protective services or (3)brain injuries, fractures or retinal hemorrhages incompatible with, or without history of trauma. Cases of iTBI were used to calculate the incidence for each year. Outcome parameters were compared for children with iTBI versus non-iTBI. Results During the study period 70 of 166 had iTBI (42%), resulting in an overall incidence of 7.6/100.000 live births. The single year incidence varied markedly between 3.3 and 12.4 per 100.000. The children with iTBI were younger than the children with non-iTBI (4.36 versus 7.49 months, p<0.001). Children with iTBI stayed significantly longer at the PICU (7.10 versus 3.92 days, p<0.01) and in hospital (27.62 versus 7.59 days, p<0.001), and were significantly longer on mechanical ventilation (4.23 versus 1.65 days, p<0.01). iTBI was associated with a significantly higher mortality rate as compared with non-iTBI (23% vs 2%, p<0.001). Conclusions Of young children admitted to Dutch PICUs with TBI 42% had iTBI. The overall incidence of iTBI was 7.6/100.00. The children with iTBI had a significantly higher mortality rate of almost 25%.