| Objectives The aim of this study is to understand the current status of traumatic brain injury(TBI)among children in Shantou through the investigation and determine its cause,distribution and clinical characteristics.Then the influencing factors of severe TBI and its cost and composition of hospitalization were discussed to provide a basis for the prevention and control of pediatric TBI and medical cost sharing.MethodsThe convenience sampling method was adopted to select children admitted to a comprehensive tertiary Level-A hospital in Shantou,Guangdong Province from May to December 2020 for TBI as the subjects.New hospitalized cases were acquired according to the inclusion and exclusion criteria,and at least 288 cases were collected.Through literature review and expert revision,the Questionnaire for Children Admitted to Hospital for Traumatic Brain Injury in Shantou was formed,and the data were collected by 3 nurses of ward with standardized training in accordance with the investigators’ manual.The data were processed and cleaned by Office 365 Excel.SPSS 21.0 was used for statistical analysis,and the mean(standard deviation)and median(quaternary interval)were used for statistical description.Chi-square test or Fisher’s exact probability method was used to examine the differences between groups in the occurrence of severe TBI.Unconditional Logistic regression was used to identify the influencing factors of severe TBI in children,and Odds Ratio(OR)and its95% confidence interval were calculated.Based on the Haddon matrix model,the host,media and environmental factors involved before,during and after the occurrence of traumatic brain injury in children were analyzed,and the measures of compulsory intervention,engineering intervention,economic intervention,educational intervention and first-aid intervention were put forward as suggestion.ResultsA total of 291 effective cases were collected in this study,including 189 males(64.95%)and 102 females(35.05%).The mean age of the patients was(9.04±5.87)years,and the proportion of the upper grade of primary school was relatively low(7.22%),followed by the lower grade of primary school(13.06%),middle school and the equivalent age group(17.53%).More than 90%(93.81%)of the local patients in Shantou lived with their parents.The main research results are as follows:1.The sex ratio of children hospitalized for TBI was 1.85:1.The high incidence of injury accidents occurred between 12:00 and 18:00 in the afternoon of every day.The proportion of children hospitalized for TBI in rural areas was higher than that in urban areas.Road traffic crashes,falls and tumble were the top three causes of injury in children admitted to hospital with TBI.2.The main injury types of TBI in hospitalized children were closed injury,epidural hematoma,subdural hematoma,traumatic subarachnoid hemorrhage and brain contusion with intracranial hematoma were the first four types of injury.The incidence of multiple trauma was 41.24%,and the proportion of severe TBI was12.03%.1.37% of the children were discharged from the hospital for possible plant survival,and 11.00% of the children were at risk of disability.3.Injury type is the main influencing factor of severe TBI in children,and the risk of road traffic accident is the highest.In road traffic crashes,vulnerable road traffic users are TBI victims and less than 2.00% of them use helmets or child restraint system.Lack of protection or poor protection effect is an important cause of fall,and the included factors have no significant effect on children’s severe TBI.4.The median hospitalization time of children hospitalized for TBI in Shantou was 12 days,causing 8,836 yuan of average hospitalization cost,8.04 million yuan of total hospitalization cost,and 2.11 million yuan of missing work.The proportion of medical burden sharing in TBI of children caused by road traffic crashes by medical insurance is only13.91%.ConclusionsThe top three causes of traumatic brain injury in children in Shantou were road traffic crashes,falls and tumble.The proportion of severe TBI in children caused by road traffic crash was the highest and the medical burden was the heaviest.Vulnerable road traffic users were the main intervention groups,and helmets and child safety seats were the recommended protective measures.With the acceleration of urbanization,related TBI has become increasingly prominent,and its prevention and control work should not be ignored.In terms of prevention and control strategies and measures,compulsory intervention,legislative intervention and educational intervention should be taken as the focus,and targeted intervention measures should be taken to reduce pediatric traumatic brain injury.Future research should adopt random,multi-center and large-sample methods to reduce selection bias,select more applicable assessment indicators of trauma severity according to the physical characteristics of children of different ages,and quantify the evaluation indexes of indirect economic burden more accurately. |
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