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July 2005

Prehospital and In-Hospital Mortality: A Comparison of Intentional and Unintentional Traumatic Brain Injuries in Colorado Children

Author Affiliations

Author Affiliations: Departments of Pediatrics (Dr Sills) and Psychiatry (Dr Libby and Ms Orton), University of Colorado at Denver and Health Sciences Center, Denver.

Arch Pediatr Adolesc Med. 2005;159(7):665-670. doi:10.1001/archpedi.159.7.665

Objectives  To describe the incidence and case-fatality rates of traumatic brain injury (TBI) in young children in Colorado, to compare these injuries based on intentionality and outcome (prehospital death, in-hospital death, or survival), and to model the association of intentionality with TBI-related mortality.

Methods  Cases were drawn from the 1994-2002 Colorado Traumatic Brain Injury Surveillance System. Incidence and case-fatality rates for intentional and unintentional TBI were calculated. We performed univariate comparisons based on the intentionality and outcome of the TBI. Multivariate logistic regression was used to estimate the association of intentionality and mortality, controlling for injury severity.

Results  Of the 1333 children aged 0 to 36 months with TBI, 340 had intentional and 993 had unintentional TBI. Incidence for intentional and unintentional TBI was 16.1 and 47.0 per 100 000, respectively. Children with intentional TBI had a higher case-fatality rate, in-hospital death rate, and injury severity. Intentional TBI deaths were twice as likely to occur in hospital than prehospital, whereas unintentional TBI deaths were twice as likely to occur prehospital. Intentionality was significantly associated with mortality, with the effect increasing with increasing age.

Conclusion  Intentionality—independent of severity—raises the mortality of TBI in young children.