Epidemiology, Outcomes, and Costs of Pediatric Traumatic Brain Injury Treated in the ICU

Traumatic brain injury (TBI) is a significant global cause of disability and mortality in childhood and adolescence, placing a huge preventable burden on patients, families, and society. The paediatric patient population contains great variation in normal physiology and anatomy, as well as in injury characteristics. It has been debated whether children have better outcomes than adults after TBI. Comparisons are complicated by the natural course of the developing versus the developed central nervous system (CNS). In the developing CNS, the full magnitude of disability might not manifest until years after an injury with increasing environmental demands, a phenomenon not seen in the adult population, where slow degeneration is the expected course, with or without injury. Due to possible pituitary insult and disruption of multiple hormonal axes, the risk of extracranial manifestations, such as delayed puberty or short stature, is also unique to the pediatric population. The most severely injured patients need treatment in the intensive care unit (ICU). However, injuries of all severities are admitted to ICUs in Europe, with mild injuries often accounting for over a third of the total patient population. Large, high-quality trials are hard to conduct, and there is little evidence to guide the medical management of this heterogeneic patient group in the ICU. In this chapter, we describe the epidemiology, outcomes, and costs of pediatric TBI treated in the ICU and highlight why this understudied population needs further multinational collaborative efforts.