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Age distribution by gender for traumatic brain injury (TBI) in a paediatric population. Access the article online to view this figure in colour.
Source publication
Introduction
The Phillips Report on traumatic brain injury (TBI) in Ireland found that injury was more frequent in men and that gender differences were present in childhood. This study determined when gender differences emerge and examined the effect of gender on the mechanism of injury, injury type and severity and outcome.
Methods
A national pro...
Context in source publication
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Citations
... Pediatric-TBI (pTBI), a leading cause of disability in children and adolescents [14] can lead to physical, neurological, cognitive and neuropsychiatric disorders [15,16]. Many factors have been shown to affect outcomes of pTBI, among them are: pre and postinjury environmental factors [17], injury severity [18], time since injury [19,20], and child's sex and age at injury [15,21,22]. During development, age may mask differences in outcomes related to the role of sex on recovery, specifically when referring to injuries occurring during critical developmental and maturation periods. ...
... During development, age may mask differences in outcomes related to the role of sex on recovery, specifically when referring to injuries occurring during critical developmental and maturation periods. Emerging literature suggests that both the response to injury and the path to recovery may differ between male and female children and adolescents [21,23]. Unfortunately, research on pTBI seldom separates females and males in their analyses [24], and the literature on outcomes is relatively limited. ...
Background
Examining the role of sex on recovery from pediatric TBI (pTBI) is a complex task, specifically when referring to injuries occurring during critical developmental and maturation periods. The effect of sex hormones on neurological and neuropsychiatric outcomes has been studied among adult TBI females, but not in children. During development, puberty is considered a key milestone accompanied by changes in physical growth, neuronal maturation, sex hormones, and psychological symptoms. Following pTBI, such changes might have a significant effect on brain re-organization and on long-term neuropsychiatric outcomes. While hormonal dysfunction is a common consequence following pTBI, only few studies have systematically evaluated hormonal changes following pTBI.
Aims
To describe a multimodal protocol aimed to examine the effect of puberty on brain connectivity and long-term neuropsychiatric outcomes following TBI in female girls and adolescents.
Methods
A case-control longitudinal prospective design will be used. 120 female participants aged 9 to 16 years (N = 60 per group) will be recruited. In the acute phase (T0-1 month), participants will undergo an MRI protocol for brain connectivity, as well as a clinical evaluation for puberty stage and hormonal levels. In the chronic phase (T1-18-24 months), participants will complete a neuropsychiatric assessment in addition to the MRI and puberty evaluations. Hormonal levels will be monitored at T0 and T1. A moderation-mediation model will be used to examine the moderating effects of puberty on the association between pTBI and neuropsychiatric symptoms in female girls and adolescents, through the mediating effect of brain network connectivity.
Significance
This study will highlight sex-specific factors related to outcomes among females following pTBI and enhance our understanding of the unique challenges they face. Such information has a substantial potential to guide future directions for research, policy and practice.
... They are also less inclined to use protective devices and are more prone to intentional injuries. This leads to a distinct injury pattern, potentially resulting in elevated levels of associated harm and mortality (Collins et al., 2013). ...
... Risk factors for a prolonged recovery period have included age, with some studies showing that very young children and adolescents require more time to recover from mild TBI [26,27]. Although TBI is more common among males as shown in this study and in the literature [28,29] due to their involvement in rough competitive play, aggressiveness and social expectations, which accept aggression among boys [30][31][32], being a female has been shown to be a risk factor for a prolonged recovery [33]. Moreover, recent studies shown that having a history of repetitive concussions leads to more significant physical and cognitive consequences, prolonged recovery and LOS [33][34][35][36][37]. ...
Purpose
This study examines the relationship between birth order and length of hospitalization due to pediatric traumatic brain injury (TBI).
Methods
We prospectively followed 59,469 Finnish newborns from 1987 until age 18 years. Data on first diagnosis of TBI was recorded within the 1987 Finnish Birth Cohort (FBC). Hospitalization period was divided into two categories: 2 days or less and more than 2 days. The latter was considered in this study as longer hospitalization.
Results
Compared with first born siblings, later born siblings had an increased risk of a longer hospitalization for TBI (12.7% of fourth or higher born birth children diagnosed with TBI were hospitalized for 2 or more days, 11.3% of first born, 10.4% of third born and 9.0% of second born). Fourth or higher born children were more likely to experience a repeat TBI; 13.4% of fourth or higher born children diagnosed with TBI had 2–3 TBIs during the study period compared to 9% of third born, 7.8% of second born and 8.8% of the first born. Injuries in the traffic environment and falls were the most common contributors to pediatric TBI and occurred most frequently in the fourth or higher birth category; 29.3% of TBIs among fourth or higher birth order were due to transport accidents and 21% were due to falls.
Conclusions
This study revealed a significant increase in risk for longer hospitalization due to TBI among later born children within the same sibling group. The study provides epidemiological evidence on birth order as it relates to TBI, and its potential to help to explain some of the statistical variability in pediatric TBI hospitalization over time in this population.
... Findings like extra Dural haematomas were mostly highly shown in boys with 14% and subdural haematomas in girls with 11%. Mortality rate varies in both male and female with ratio of 4:2 20 . ...
Aim: To find the utility of brain CT in highlighting the etiological patterns and incidental findings of traumatic brain injury. Methods: From January 2022 to March 2022, 110 patients presenting to emergency department of Pakistan Institute of Neurosciences with brain traumatic injury was present in this study. Patients go through long clinical evaluation and computed tomography on every trauma criteria. Results: The most affected age (group) was 30 to 42 years (37.05%) male (78.2%) to female (21.8%) ratio was 8:2. Injuries were predominantly caused by RTA (72.7%), less commonly caused by fall (11.8%), pedestrial (6.4%), assault (5.5%), and sports (3.6%). Among those with RTA less than 6% people was wearing helmet. The common CT scan evaluation was brain contusion (35%), fracture (13%), Edema (13%), SDH (10%), EDH (8%), SAH (4%), pneumocephalus (5%) and others (3%). Prediction of true prevalence of incidental findings is tough. In this study, we found that enlarged cisterna magna (3.6%) and calcification (3.6%) were the common incidental (findings), and brain tumor (0.9%) and hydrocephalus (0.9%). Conclusion: Road traffic accidents (RTA) are a major cause of TBI. This can be avoided by wearing helmet, but it is less used. Moreover, there is a proper need to put strict system amongst hospitals citywide to lessen the effects of severe TBI. At last every person had to check up on themselves for any minor physical or mental change. Keywords: Traumatic Brain Injury, CT scan, Etiological patterns, Incidental findings.
... Collins et al. 's data showed that boys were generally less likely to use protective devices and more likely to be injured deliberately. Additionally, boys appear to be at higher risk of injuries that are intentional 46 . Furthermore, widespread cultural and societal norms often allow for greater tolerance for high-risk behaviors among male children, which includes relaxed behavior related to wearing car seatbelts 46,47 . ...
... Additionally, boys appear to be at higher risk of injuries that are intentional 46 . Furthermore, widespread cultural and societal norms often allow for greater tolerance for high-risk behaviors among male children, which includes relaxed behavior related to wearing car seatbelts 46,47 . This is consequential since road collisions are a major source of pediatric TBIs 48,49 . ...
Pediatric traumatic brain injury (TBI) is a significant problem of public health importance worldwide. Large population-based studies on the effect of birth order on health phenomena are exceedingly rare. This study examines the relationship between birth order and risk for pediatric TBI among sibling groups. We performed a retrospective cohort study following 59,469 Finnish newborns from 1987 until age 18 years. Data on first diagnosis of TBI was recorded within the 1987 Finnish Birth Cohort (FBC). Compared with first born siblings, later born siblings had an increased risk of TBI during the follow-up period (hazard ratio [HR] 1.02; 95% confidence interval [CI] 0.91-1.14 for second born, HR 1.09; 95% CI 0.95 1.26 for third born, HR 1.28; 95% CI 1.08-1.53 for fourth or higher). When adjusted for sex and maternal age at child's birth, HRs (95% CIs) for TBI during the follow-up period were 1.12 (0.99-1.26) for second born, 1.31 (1.12-1.53) for third born and 1.61 (1.33-1.95) for fourth born or higher children, respectively. Within this large register-based population-wide study, order of birth modified risk for pediatric TBI among sibling groups. Taken together, these study findings may serve to stimulate further inquiry into genetic, psychological, or psychosocial factors which underlie differences in risk and depth of effect within and between sibling groups.
... Another factor may be risk-taking behaviors that may be associated with interactions between sex and mechanism, with males sustaining higher energy transfer injuries or lacking the use of protective devices. However, we do not have such details in our dataset (33). Differences in outcomes between sexes may be more evident later in the trajectory following injury and therefore continued tracking of outcomes for months to years is critical (13). ...
The interaction of age, sex, and outcomes of children with head injury remains incompletely understood and these factors need rigorous evaluation in prognostic models for pediatric head injury. We leveraged our large institutional pediatric TBI population to evaluate age and sex along with a series of predictive factors used in the acute care of injury to describe the response and outcome of children and adolescents with moderate to severe injury. We hypothesized that younger age at injury and male sex would be associated with adverse outcomes and that a novel GCS-based scale incorporating pupillary response (GCS-P) would have superior performance in predicting 6-month outcome. GCS and GCS-P along with established CT scan variables associated with neurologic outcomes were retrospectively reviewed in children (age birth to 18 years) with moderate or severe head injury. GOS-E was prospectively collected 6 months after injury; 570 patients were enrolled in the study, 520 with TBI and 50 with abusive head trauma, each analyzed separately. In the TBI cohort, the median age of patients was 8 years and 42.7% had a severe head injury. Multiple predictors of outcome were identified in univariate analysis; however, based on a multivariate analysis, the GCS was identified as most reliable, outperforming GCS-P, pupil score, and other clinical and CT scan predictors. After stratifying patients for severity of injury by GCS, no age- or sex-related effects were observed in our patient population, except for a trend toward worse outcomes in the neonatal group. Patients with abusive head trauma were more likely to have severe injury on presentation, increased mortality rate, and unfavorable outcome. Additionally, there was clear evidence that secondary injuries, including hypoxia, hypotension, and hypothermia were significantly associated with lower GCS and higher mortality in both AHT and TBI populations. Our findings support the use of GCS to guide clinical decision-making and prognostication in addition to emphasizing the need to stratify head injuries for severity when undertaking outcome studies. Finally, secondary injuries are a clear predictor of poor outcome and how we record and manage these events need to be considered moving forward.
... We found 30% of our cases reported head trauma. This can be attributed to increased physical activity and contact sports among children, especially in boys [13]. Zeitler et al. and R D Cullen et al. had reported head trauma as a leading cause for device failure in 41% of their RIS [14,15]. ...
Introduction
Revision cochlear implant surgery (RIS) is an unusual and unfortunate event, but not an uncommon occurrence in today's time, with more and more children being implanted. It is accepted that a pediatric cochlear implant recipient may require one or two revision procedures during their lifetime. The indication of RIS can be due to a multitude of causes like trauma, device failure (hard failure or soft failure), infection at the implant site, electrode extrusion, device migration, magnet migration, and upgradation in the technology. Scenarios, where the child is deprived of hearing once again is worrisome for the family. And, they need financial and psychological assistance as well.
Aims and objectives
(1) To scrutinize the socio-demographic profile of children who underwent RIS. (2)To profile the social, intellectual, and economic backgrounds of these families.
Material and methods
A retrospective, observational, non-interventional, cohort study conducted at the Implantation otology department of Madras ENT Research Foundation (MERF), Chennai, Tamil Nadu, India. Data collection: (1) Detailed medical records of all the children who satisfied the inclusion criteria were reviewed.(2)This was followed up by a telephonic interview with the guardian of the consenting patients, to obtain further data based on a customized questionnaire. Sample size: Of the 99 children who underwent RIS, 80 families consented to be part of the study. Statistical analysis:(1) Cause of revision implant surgery and Family system Risk estimate.(2) Correlation of sex, family system, patient non-compliance to habilitation, and residential area with RIS.(3) Correlation of the residential area of the patient with completion of 1-year habilitation.
Results
A significant association observed between RIS and Sex (P = 0.03). A significant co-relation between patient non-compliance to habilitation and cause of revision implant surgery observed (P = 0.02). A significant co-relation was seen between residential area (Rural/Urban) and cause of RIS (P = 0.02). A statistically significant correlation seen with the residential area (Rural/Urban) of the child and completion of 1-year habilitation (P = 0.01). Uni-variant association was found between patients that have completed one year of habilitation, patient compliance, and modified Kuppuswamy Socio-Economic status.
Conclusion
The current data has aided in refining our institutional management protocols and predicting high-risk candidates who may need revision surgery in the future. Based on the data, all cochlear implantees and their families especially in the lower socio-economic strata, are now being meticulously educated about device care, the possible reasons for failures, and the importance of timely re-intervention.
... Our results showed gender-related health inequalities, with significantly higher mortality rates in men, as confirmed by other studies [13,30]. Risky driving behaviors among men are common at an early age and are observed throughout the life cycle. ...
Background:
Deaths due to traffic accidents are preventable and the access to health care is an important determinant of traffic accident case fatality. This study aimed to assess the relation between mortality due to traffic accidents and health care resources (HCR), at the population level, in 66 sub-regions of Poland.
Methods:
An area-based HCR index was delivered from the rates of physicians, nurses, and hospital beds. Associations between mortality from traffic accidents and the HCR index were tested using multivariate Poisson regression models.
Results:
In the sub-regions studied, the average mortality from traffic accidents was 11.7 in 2010 and 9.3/100.000 in 2015. After adjusting for sex, age and over time trends in mortality, out-of-hospital deaths were more frequently compared to hospitalized fatal cases (incidence rate ratio (IRR) = 1.68, 95% CI 1.45-1.93). Compared to sub-regions with high HCR, mortality from traffic accidents was higher in sub-regions with low and moderate HCR (IRR = 1.25, 95% CI 1.11-1.42 and IRR = 1.19, 95% CI 1.02-1.38, respectively), which reflected the differences in out-of-hospital mortality most pronounced in car accidents.
Conclusions:
Poor HCR is an important factor that explains the territorial differentiation of mortality due to traffic accidents in Poland. The high percentage of out-of-hospital deaths indicates the importance of preventive measures and the need for improvement in access to health care to reduce mortality due to traffic accidents.
... The findings of our study is in agreement with some other studies conducted in different parts of the world. The possible reason of high prevalence of traumatic brain injury among boys could be the outdoor engagement and risky behaviors resulting in high energy transfer [15][16][17][18]. Concerning regarding mechanism of traumatic head injury, fall was the most common etiology followed by road traffic accident and assault. ...
... Boys usually encounter injuries associated with higher energy transfer and are also less likely to use protective devices and thus are more likely to face the traumatic injuries deliberately. 47 In addition, ...
Background/aim
The varied prevalence of traumatic dental injuries in primary teeth around the globe raises a serious knowledge gap in the available literature. The aim of this study was to evaluate the prevalence of TDI in primary teeth and also to evaluate the different factors associated with TDI in primary teeth.
Materials and methods
Comprehensive searches were performed in PUBMED, EMBASE, Google Scholar, and The Cochrane Central Register of Controlled Trials with predefined search criteria. The primary outcome was the prevalence of TDI in primary teeth and the secondary outcomes were the factors associated with TDI in primary teeth. Qualitative analysis was done using the Newcastle‐Ottawa scale adapted for cross‐sectional studies. The Random‐effect model was used for meta‐analysis and meta‐regression analysis was done to evaluate the heterogeneity between the included studies. Meta‐analysis was done using the “meta” package of ‘R’ language. The overall quality of evidence was assessed using GRADEpro GDT software.
Results
A total of 24 cross‐sectional studies met the inclusion criteria representing 4,876 TDIs in 22,839 children aged between 0‐6 years old. The overall prevalence of TDI in primary teeth was 24.2% (95% CI: 18.24 ‐ 31.43, p = 0, I²=99%). Falls contributed the highest number of TDI 59.3% (95% CI: 41.05 ‐ 76.40, p < 0.01, I²=98%) in primary teeth. The most common type of tooth fracture in primary teeth was enamel fracture (61.9%) and prevalence of TDI in children with incompetent lip closure was 49.4%.
Conclusion
The prevalence of TDI in cross‐sectional studies of primary teeth was 24.2% with very low quality of evidence. Falls contributed the highest number of TDI in primary teeth, accounting for 59.3%. Children with incompetent lip closures have the highest prevalence (49.4 %) of TDI in primary teeth.
