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A recent systematic review has found that traumatic brain injury (TBI) is more likely to occur in the formative years of young male children in low- and middle-income countries (LMICs) - and this has implications for lifetime healthcare costs, as well as an increased risk of behavioural disorders.

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Injuries are the leading cause of death and disability. TBI has been identified to be the injury that is most likely to lead to death or permanent disability. TBI occurring in children represent a different challenge to that presented by TBI in adults. In addition to the consequences of TBI being different between adults and children, the causes likely differ too. Therefore, a team of researchers, led by Dr Soham Bandyopadhyay at the Oxford University Global Surgery Group, choose to conduct a review primarily focusing on children, so that data from adults did not affect the interpretation of the results.

Another aspect of TBI research that needs to be considered is that the causes and consequences of TBI likely differ between children who live in different countries, for example due to different healthcare systems or differing lifestyles. This disparity is highlighted by the gulf between the healthcare systems of low- and middle-income countries (LMICs) and high-income countries (HICs). This review, published in World Neurosurgery, decided to focus on the causes and outcomes of TBI in children in LMICs as there is no previous review on this topic and because children form the majority of the population in many LMICs.

The systematic review summarised the published literature on the causes, death and disability of TBI in children in LMICs. Less than one-quarter of LMICs had published data of sufficient quality about TBI in children in their country. The commonest cited causes of childhood TBI were road traffic accidents and falls. For every 1000 children that had TBI, 73 died. Of those who survived, nearly 25% had a reduction from their normal function on discharge. 

The review found that TBI was more likely to occur in the formative years of childhood in LMICs, which is in contrast to studies from the USA, where children were more likely to get TBI in their mid to late teens. This has implications for lifetime spending on healthcare costs, as families in LMICs may be paying for management and rehabilitation from an earlier point in their child’s life due to injuries occurring at a younger age. This could exacerbate the number of individuals facing catastrophic expenditure for healthcare. In addition, TBI at an earlier stage of life has developmental consequences. TBI is associated with an increased risk of behavioural disorders and subsequent criminal activity. Preventing TBI would reduce the burden on community resources aimed at promoting recovery and rehabilitation.

The review also found that TBI is more likely to occur in males than females. This finding could be explained by previous research that has shown that parents are less likely to restrain the exploratory behaviour of male children than female children, even if said behaviour poses an injury risk. Female children are more likely to be supervised by someone who might protect them from injury, as male children are given more freedom to roam further from their home and be without adult supervision. Male children are also more likely to engage in risky behaviour. Thus, there is a need for targeted injury prevention campaigns that aim to prevent situations that may provoke risk taking behaviour and reduce risk in situations that children find themselves in. A targeted approach to reduce the incidence of TBI in LMICs could be creating road safety resources for children, building sidewalks – and therefore making clearly defined roads –, increasing traffic lights, creating protected playgrounds, and providing children with bright clothing (fluorescent clothes for the day and reflective clothes for the night).

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