Publication:

Traumatic brain injury in infants and children: emergency management and prognostic factors – a meta-analysis

Traumatic brain injury (TBI) is a leading cause of mortality, disability, and long-term neurodevelopmental impairment in children worldwide. Despite advances in emergency and neurocritical care, optimal management strategies and prognostic factors across injury severities remain incompletely understood. The objectives of the study were to evaluate emergency management approaches, clinical outcomes, and prognostic factors associated with pediatric TBI and identify predictors of morbidity and mortality. This meta-analysis followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines and included studies published between January 2022 and March 2026. Randomized controlled trials, cohort studies, case-control studies, registries, and systematic reviews assessing pediatric TBI were eligible. Data on patient characteristics, injury patterns, emergency interventions, and outcomes were extracted. Random-effects models were used to calculate pooled estimates, with subgroup and sensitivity analyses performed to assess heterogeneity. Twenty-five studies were included in the qualitative synthesis, and 25 met criteria for quantitative meta-analysis. Early protocol-driven emergency care significantly improved survival (OR 1.42, 95% CI 1.18-1.71) and reduced secondary brain injury (RR 0.74, 95% CI 0.63-0.87). Prevention of hypoxia and hypotension was strongly associated with favorable neurological outcomes. Intracranial pressure monitoring and hyperosmolar therapy demonstrated benefits in severe TB.