Factors affecting mortality risk in pediatric head injuries in Africa: a meta-analysis.

PURPOSE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.