CHAPTER ONE: INTRODUCTION

1.1. Background

Traumatic brain injury (TBI), caused by a bump, blow, or jolt to the head or a penetrating injury, disrupts normal brain function [1] The Glasgow Coma Scale (GCS), a widely used 3-15point scale, categorizes TBI severity as severe (GCS 3-8), moderate (GCS 9-12), and mild (GCS 13-15.) [2,3]. TBI  contributes to worldwide death and disability surpassing other traumatic injuries [4,5]. The true scope of TBI, including regional variations and socioeconomic disparities, remains unclear [4]. Low- and middle-income countries bear a significant burden from TBI [6,7]. ]. Global incidence of paediatric TBI varies widely between countries, with most reports ranging from 47 to 280 per 100,000 children [8]. Acktah et al.’s study suggests that 18% of children aged 0-18 experience TBI, with nearly 10% dying in Sub-Saharan Africa [5]. A study by Ndoumbe et al. at Yaounde General Hospital in Cameroon found a 10.43% prevalence of paediatric TBI. The global and Sub-Saharan African mortality rates for paediatric TBI are estimated at 7,000 deaths [8] ] and 8.6%, respectively [5]. In Cameroon the mortality rate of mild and moderate TBI is 2.06% and that of severe traumatic brain injury is 33.3%[9]. Traumatic brain injury (TBI) can occur through four main mechanisms: direct impact, rapid acceleration/deceleration, penetrating injury, and blast injury [10] . Common causes of paediatric TBI include falls, motor vehicle crashes, assaults, fights, sports injuries, and firearm-related injuries. [11–13]. Researchers in Douala, Cameroon conducted a study in 2022, led by Buh et al., which investigated road traffic accidents (RTAs) as the leading cause of TBI in the country, primarily affecting young adult males.

Management of paediatric TBI can involve observation, conservative (non-surgical) methods, or surgical intervention. Conservative methods include elevating the head of the bed, hyperventilation, fluid management, management of cerebrospinal fluid (CSF) drainage and pressure, blood pressure monitoring, venous thromboembolism prophylaxis, blood sugar control, and anti-seizure medication. Surgical approaches depend on the injury type, with craniotomy being the most common intervention, followed by craniectomy and burr hole procedures Potential complications of TBI include cognitive impairment, sensory processing and communication difficulties, immediate seizures, hydrocephalus, CSF leakage, vascular and cranial nerve injuries, tinnitus, and polytrauma [16]. ]. In 2017 a study done by Takashi et al. in Japan on paediatric TBI emphasized the importance of a multidisciplinary approach throughout all phases of management for optimal care [11]. This approach includes prompt diagnosis and multimodal monitoring after initial evaluation to minimize damage to the developing brain Challenges in managing paediatric TBI include lack of prehospital care, Lack of prehospital care, financial constraints limiting both CT scanning and medical care, and lack of acute physiotherapy service likely influence management care and outcome adversely[17]. This study will describe the epidemiological profile and management of paediatric traumatic brain injury at BRH because most studies have been carried out on the adult population and limited studies in the paediatric age group.

1.2. Problem Statement

Traumatic brain injury is a global health concern due to its high burden of morbidity and mortality[9]. In sub-Saharan Africa, TBI accounts for over 40% of all neurosurgical admissions in both adults and children. An estimated 3.2 million people sustain TBI annually in the region, with this number projected to rise to 14 million by 2050  [4]. Previous studies in Cameroon found that the prevalence of paediatric TBI was 10.43% done at the Doula General Hospital. However, it’s been close to 7 years since the last study was done to the best of our knowledge on epidemiology and management of paediatric TBI. There have been increased access to specialists in neurosurgery and availability of CT scans in management of this cases, hence paucity of clinical studies and literature in this age group Therefore the need-to-know present day situation. In addition, most studies carried out on traumatic brain injury have been done in administrative and economic cities of the country so there is a need to know what happens at the periphery. Which will be used to compare with what happens in the other regions and make generalities about the epidemiology of Paediatric TBI In Cameroon as a whole. Moreover, the majority of TBI guidelines for paediatric patients are adapted from the management of TBI in adults, which may be inappropriate owing to the inherent physiological and anatomical differences between these two demographics such as less severe injuries and better prognosis. This study seeked to gather data on how paediatric TBI was managed at BRH to inform the development of context-specific guidelines [5,9].

1.3. Justification/Rational

Paucity of clinical data: More than 80% of Research on TBI is done in the developed countries whereas 80% of these cases happen in developing countries, with Cameroon not being exclusive. As such, there is a need for more research to be carried out to enable us improve on morbidity and mortality of this major public health problem. Also, to the best of our knowledge, no study has been done on the management of Paediatric TBI in Bamenda. Our study thus went a long way to bridge the paucity of data. The paucity of clinical data in the following areas; Aetiology and management: Investigating the epidemiological profile and management of paediatric traumatic brain injury provides insight into the aetiologies associated with this condition. Identification of these aetiologies can go a long way in development of management strategies and public health interventions aimed at reducing the prevalence and management of patients with TBI; Rehabilitation services: The epidemiological profile of paediatric TBI and management can guide the development and improvement of rehabilitation services like speech and cognition, psychosocial and mental health. Understanding the difficulties encountered by paediatric patients with TBI at the BRH will create more awareness to healthcare providers in order that rehabilitation programs be directed to these patients to meet their requirements effectively and efficiently.

1.4. Research Goal

The goal of our study was to investigate the epidemiological characteristics of paediatric traumatic brain injury and contribute towards the improvement of management in our setting.

1.5. Research Question

1. What is the epidemiological profile of paediatric TBI at Bamenda Regional Hospital (BRH)?
2. What are the management modalities of paediatric TBI?

1.6. Research Hypothesis

The epidemiological profile and management of paediatric traumatic brain injury at the BRH will brandish distinct features in terms of incidence, etiologies, clinical features and different management principles.

1.7. Research Scope

The scope of this study was to analyse the epidemiological profile and management of paediatric traumatic brain injury at the BRH. The study highlighted the following aspects:

– Prevalence, aetiologies, clinical profile and radiologic findings of paediatric traumatic brain injury

– Different management principles which could either be observation, conservative and surgical management. 

– Clinical outcome of paediatric TBI using the standardized Glasgow Outcome Score (GOS) at discharge.

1.8. Research Objectives

1.8.1. General Objectives

To assess the epidemiological profile and management of paediatric Traumatic Brain Injury at the Bamenda Regional Hospital.

1.8.2. Specific Objectives

1. To determine the prevalence of Paediatric Traumatic Brain Injury.
2. To outline its aetiologies.
3. To identify the radiologic findings
4. To describe the management.
5. To enumerate the factors associated with poor outcome.