Underreporting of Traumatic Brain Injuries in Pediatric Craniomaxillofacial Trauma: A 20-Year Retrospective Cohort Study

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This 20-year retrospective study examined traumatic brain injury (TBI) among children under 15 treated for craniomaxillofacial (CMF) fractures at a tertiary trauma center from 1990 to 2010.<br /><br />Among 2,966 patients, 809 (27.3%) had a concomitant TBI. Yet only 13 of those cases (1.6%) were explicitly documented as TBI in the medical record. Most TBIs were mild (64.4%); 24.5% were severe and 7.4% moderate. Patients with TBI had higher injury severity, lower Glasgow Coma Scale scores, longer hospital stays, and greater two-year mortality than patients without TBI. Mortality rose with TBI severity, reaching 27.3% among children with severe TBI. TBI was more common in patients with skull or upper-face fractures and less common with middle-face fractures.<br /><br />The findings suggest that TBI is frequent but substantially underrecognized in pediatric CMF trauma, and that more severe injuries are associated with poorer outcomes. The authors recommend that clinicians assess and document possible TBI in all pediatric CMF trauma patients and coordinate care with neurology or neurosurgery teams. Prospective research is needed to guide consistent diagnosis and management.<br /><br />Because the study was retrospective, relied on records from one center, and required imaging-confirmed fractures, its results may not generalize to all settings or capture every injury.

Keywords

traumatic brain injury

pediatric trauma

craniomaxillofacial fractures

children under 15

retrospective study

tertiary trauma center

Glasgow Coma Scale

injury severity

mortality

underdiagnosis