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Table 6 Pediatric head injury studies from the Middle East Region (2007–2016)

From: Pediatric Traumatic Brain Injury: a 5-year descriptive study from the National Trauma Center in Qatar

Author (year) Country and Study duration Study sample size and Inclusion/exclusion criteria Mechanism of Injury Injury severity Incidence/mortality
Iranmanesh (2009) [23] Iran, 2003–2005 380 head trauma
Inclusion: patients admitted with brain injury; age < 18 years Exclusion: not reported
MVC 72%; falls 11% No GCS reported; abnormal skull radiographs 12%; abnormal brain-CT scans 17% Head trauma was 32%. Most affected age groups: 7–12 years (43%) and 12–18 years (35%).
TBI mortality 7%
Assiry et al. (2014) [20] KSA, 2012- 71 head trauma
Inclusion: pediatric head trauma (age ≤ 16 years). Exclusion: not reported
MVC 63%; falls 32% Not reported Most affected age group: > 7–16 years (55%)
Alhabdan et al. (2013) [12] KSA, 2001–2009 1219 head trauma
Inclusion: any head injury in pediatric patients (age ≤ 18 years); patients admitted or died at ED Exclusion: not reported
MVC (34%); pedestrian (30%); falls (28%). Median (range) GCS 11
(3–15); mean ISS 16.6 (range 1–75)
Most affected age group: < 12 years (66%);
Mortality 15%; 50% died on arrival
Fakharian et al. (2014) [24] Iran, 2004–2010 604 infant head trauma
Inclusion: infants (< 24 months) with head trauma; hospitalized for > 24 h. Exclusion: birth trauma
Falls (63%) GCS: (14–15) 99%; (≤ 13) 1%; mean GCS 14.93 ± 0.8 Head trauma in infants (≤ 24 m) was 21% of all children (< 15 years); mortality 0.8%; in-hospital mortality 6.6 per 100,000 infants.
Lotfi-Sadigh et al. (2015) [25] Iran, 2011–2014 218 children with blunt head trauma
Inclusion: minor blunt head trauma (GCS 14 or 15); presented to ED within 24 h of trauma; age < 2 years. Exclusion: no signs or symptoms of head trauma other than scalp abrasions or lacerations; penetrating trauma; comorbidities (ventricular shunt or bleeding disorders); previous neuroimaging; patients left ED against medical advice
Falls 74%; MVC 14% Head trauma was defined as GCS 14 or 15; abnormal CT findings in 8% No mortality was reported due to mild head trauma
Alharthy et al. (2015) [26] KSA, 2011 289 children with blunt head trauma. Inclusion: blunt head injury; age 1–14 years; GCS 13–15; presentation within 24 h post-injury; CT scan done. Exclusion: penetrating head trauma, local facial signs post trauma, signs of basal skull
Fracture; comorbidities that predispose to bleeding tendency; multiple major traumas; prolonged amnesia and LOC (prolonged amnesia and loss of consciousness for more than 5 min); active seizure on arrival to ED; GCS < 13.
Falls 53%; MVC 23% All cases were with minor head trauma; GCS 15 (94%); 14 (4%); 13 (2%); abnormal brain CT findings in 5% (of these, 53% in falls, 23% in MVC) TBI in minor head trauma among children (1–14 years) was 5%; no mortality was reported due to mild head trauma
Yagmur et al. (2016) [27] Turkey, 2008–2012 203 pre-school children deaths due to head trauma.
Inclusion: fatal head trauma in pre-school children (age ≤ 5 years); head trauma with general body trauma if cause of death was head trauma. Exclusion: cause of death other than head trauma
Falls 48%; MVC 33% All cases were fatal 18% of deaths among children (age ≤ 5 years) were due to head trauma
Klimo et al. (2015) [28] Iraq, 2004–2012 268 children with severe isolated head trauma in Iraq during Operation Iraqi Freedom (OIF).
Inclusion: pediatric head injury; age < 18 years; isolated serious head injury (defined as AIS > 3); during OEF (Operation Enduring Freedom) or OIF (Operation Iraqi Freedom). Exclusion: not reported
Penetrating injuries 61%; caused by IED (38%) or blast (25%). Median (range) GCS 7 (3–15) Of the total severe isolated head trauma among children during US military operation in Iraq and Afghanistan, 41% were Iraqi children. Mortality among the severe isolated head trauma in children was 26%
Gofin and Avitzour (2007) [29] Israel, 2001 472 head trauma in children;
Inclusion: pediatric head trauma; age 0–17 years; Israeli citizens; information about mechanism and type of injury were available. Exclusion: not reported
TBI definition by ICD-9-CM codes
Falls 46% GCS was not reported; ISS was >16 in 60% 42% of the head trauma in children (0–17 years) was TBI or possible TBI. Most affected age group: 0–4 years (51% in Jews and 57% in Arabs)
Present study Qatar, 2010–2014 167 pediatric TBI cases (≤ 18 years);
Inclusion: all pTBI cases required admission, ICD-9 codes from 800 to 959.9 Exclusion: codes 905–909.9; 910–924.9 and 930–939.9
MVC 47%; falls 22% Median (range) GCS at scene: 9 (3–15); Median (range) ISS: 19 (1–50) 18% of the total TBIs were in children; overall rate of TBIs among children in Qatar 9.5 per 100,000; most affected age group was 15–18 years (40%) followed by 0–4 years (23%). Mortality 13%