Objectives: To determine the epidemiology of pediatric traumatic brain injury (TBI) in a midwestern state and to examine differences between metropolitan and nonmetropolitan residents.
Design: Population-based case series.
Participants: Patients aged 0-19 years sustaining TBI in 1993 that resulted in hospitalization or death.
Main outcome measures: Incidence, mortality and case-fatality rates, length of hospital stay, discharge status, and Glasgow Outcome Scale score.
Results: Nine hundred seventy-seven patients met inclusion criteria. Incidence, mortality, and case-fatality rates were 73.5 per 100 000, 9.3 per 100 000, and 12.8 per 100, respectively. Higher median household incomes and percentages of adult high-school graduates in a patient's census block group correlated with lower incidence. Median length of stay was 2 days. Of those included in the study, 720 patients (74%) were discharged home with self-care. Three hundred fifty-seven patients met criteria for severe TBI; 346 (97%) were assigned Glasgow Outcome Scale scores, of which 161 (47%) had disabilities or died. Severe TBI was associated with nonmetropolitan residence, higher median household income, and certain injury mechanisms. Incidence was similar for metropolitan and nonmetropolitan residents. Median head-region Abbreviated Injury Score, Injury Severity Score, and mortality and case-fatality rates were higher for nonmetropolitan residents.
Conclusions: This study reports the lowest incidence of pediatric TBI that results in death or hospitalization to date. One half of severely injured patients suffered poor outcomes. A greater proportion of nonmetropolitan than metropolitan residents suffered severe TBI and had higher mortality and case-fatality rates.