Background: Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in children. The aim of this study was to report the burden of isolated pediatric TBI at a major trauma center in Riyadh, Saudi Arabia and assess associations with mechanism of injury. Methods: A retrospective cohort study using chart review, including children aged ≤14 years with isolated TBI over 2 years from 01 Jan 2016 to 31 Dec 2017 was undertaken. Univariable or unadjusted associations of patients presenting after motor vehicle crashes (MVC) and physiological variables were assessed. Intensive care unit (ICU) admission and mortality at hospital discharge were the primary outcome measures. Results: There were 2,501 pediatric patients that presented to the Emergency Department with head injury and 241 (9.6%) patients were admitted to hospital with isolated TBI, with an in-hospital mortality rate of 9%. MVC was the most common mechanism of injury (n = 142; 59%) followed by falls (n = 68; 28.2%), pedestrians (n = 26; 10.8%), and non-accidental injuries (n = 5; 2.1%). Patients presenting after MVC were older (p = 0.001), had similar Glasgow Coma Scale scores (p = 0.12) and more often presented in a coagulopathic state (p <0.001). Patients following MVC had higher rates of ICU admission and spent longer in hospital. Conclusions: MVC was the most common mechanism of isolated pediatric TBI requiring hospital admission and associated with significantly higher rates of ICU utilization and longer hospital length of stay. These findings highlight the urgent need for validation from other centers in the Kingdom of Saudi Arabia (KSA) and preventive strategies directed at pediatric occupants of motor vehicles in the KSA.

Keywords: Wounds and injuries, pediatrics, injuries, brain, road traffic crash, epidemiology, Saudi Arabia