Darko Kwadwo, Limann Bernice, Tenkorang Pearl Ohenewaa, Pulido Sonia, Dwumfour-Poku Nina, Bonsu Joshua O, Barrie Umaru, Banson Mabel, Totimeh Teddy
Department of Neurosurgery, Korle Bu Teaching Hospital, Accra, Ghana.
College of Health Sciences, University of Ghana Medical School, Accra, Ghana.
Childs Nerv Syst. 2025 May 31;41(1):197. doi: 10.1007/s00381-025-06859-5.
TBI-related mortality in low- and middle-income countries (LMICs) is three- to fourfold higher than that reported in high-income countries. This study aims to assess the factors affecting the risk of mortality in pediatric patients with head injuries.
A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Forty-two studies from 12 African countries were included. In the analysis of pediatric head injury, 64.3% (95% CI: 61.5-67.1%) were males, with an average age of 7.02 (95% CI: 6.00-8.04 years). The leading causes of injury were road traffic accidents (95% CI: 56.0-69.2) and falls 29.4% (95% CI: 21.0-37.9). The severity of traumatic brain injury was mild in 55.7% (95% CI: 47.3-64.1), moderate in 19.2% (95% CI: 15.1-23.4), and severe in 17.9% (95% CI: 12.0-23.8) of cases. Common reported imaging findings included skull fractures 24.6% (95% CI: 17.9-31.2) and cerebral contusions in 22.2% (95% CI: 16.5-27.9). Conservative and surgical management were employed in 70.6% (95% CI: 60.6-80.5) and 23.8% (95% CI: 15.3-32.3) of cases, respectively. The overall mortality rate was 19% (95% CI: 10.9-27.0), with road traffic accidents (RTAs) (RR: 43.7 (95% CI: 5.0-385.2, p = 0.001)) identified as a significant risk factor for mortality.
Our study emphasizes RTA and seizures at presentation as key risk factors for mortality. We recommend early preventive measures, such as infrastructure improvements, to enhance road safety and reduce mortality.
低收入和中等收入国家（LMICs）中与创伤性脑损伤（TBI）相关的死亡率比高收入国家报告的高出三到四倍。本研究旨在评估影响小儿头部受伤患者死亡风险的因素。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，使用PubMed、谷歌学术和科学网电子数据库对文献进行了系统评价。
纳入了来自12个非洲国家的42项研究。在小儿头部损伤分析中，64.3%（95%置信区间：61.5 - 67.1%）为男性，平均年龄为7.02岁（95%置信区间：6.00 - 8.04岁）。受伤的主要原因是道路交通事故（95%置信区间：56.0 - 69.2）和跌倒（29.4%，95%置信区间：21.0 - 37.9）。创伤性脑损伤的严重程度在55.7%（95%置信区间：47.3 - 64.1）的病例中为轻度，19.2%（95%置信区间：15.1 - 23.4）为中度，17.9%（95%置信区间：12.0 - 23.8）为重度。常见的影像学表现包括颅骨骨折（24.6%，95%置信区间：17.9 - 31.2）和脑挫伤（22.2%，95%置信区间：16.5 - 27.9）。分别有70.6%（95%置信区间：60.6 - ８0.5）和23.8%（95%置信区间：15.3 - 32.3）的病例采用了保守治疗和手术治疗。总死亡率为19%（95%置信区间：10.9 - 27.0），道路交通事故（RTAs）（相对危险度：43.7（95%置信区间：5.0 - 385.2，p = 0.001））被确定为死亡的一个重要危险因素。
我们的研究强调就诊时的道路交通事故和癫痫发作是死亡的关键危险因素。我们建议采取早期预防措施，如改善基础设施，以提高道路安全并降低死亡率。
