{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T22:35:41Z","timestamp":1791758141921,"version":"4.3.4"},"reference-count":199,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Paediatric traumatic brain injury (pTBI) remains a leading cause of death and disability in children around the world. The evidence to support pTBI management in children notably lags that in adult populations, with a lack of data available to inform management. Injury mechanisms and physiological responses vary considerably across the developmental spectrum of childhood, bringing unique challenges to the management of pTBI. This is compounded further by complexity of neurodevelopmental changes influencing long-term outcomes.<\/jats:p>\n                  <jats:p>The foundation of current understanding of pTBI is laid on the innovative work done over the turn of the century. Incremental progress in the past few years has furthered our understanding of mechanisms, disease pathophysiology, recovery pathways and consequences of pTBI. There are developments in identification of biomarkers that can help in diagnosis and predict outcomes more accurately to guide clinical decision-making and track long-term outcomes. However, this progress has been slow, and more work is required to translate the large body of observational work into interventions to help improve outcomes of pTBI.<\/jats:p>\n                  <jats:p>This review aims to synthesize recent findings, evaluate existing evidence and propose future research directions. Structured initially to address key epidemiological and pathophysiological differences in the paediatric population with associated clinical challenges, followed by the potential role of physiological, blood and imaging biomarkers, this review seeks to provide a comprehensive update. Additionally, it addresses current evidence gaps in therapeutic strategies, rehabilitation needs and comprehensive systems of care, integrating insights from high- and low-resource settings. Finally, it reviews current research with a view to offering recommendations to reduce the evidence gaps in pTBI.<\/jats:p>","DOI":"10.1093\/brain\/awaf459","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:07:25Z","timestamp":1765458445000},"page":"736-756","source":"Crossref","is-referenced-by-count":13,"title":["Paediatric traumatic brain injury: unique population and unique challenges"],"prefix":"10.1093","volume":"149","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8695-1314","authenticated-orcid":false,"given":"Shruti","family":"Agrawal","sequence":"first","affiliation":[{"name":"Paediatric Intensive Care, Department of Paediatrics, Cambridge University Hospitals , Cambridge CB2 0QQ ,","place":["UK"]},{"name":"Department of Paediatrics, University of Cambridge , Cambridge CB2 0QQ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3608-2792","authenticated-orcid":false,"given":"Rebekah","family":"Mannix","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Harvard Medical School, Boston Children\u2019s Hospital , Boston, MA 02115 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicki","family":"Anderson","sequence":"additional","affiliation":[{"name":"Clinical Sciences Research, Murdoch Children\u2019s Research Institute, Mental Health Service, Royal Children\u2019s Hospital & School of Psychological Science, University of Melbourne , Melbourne, VIC 3052 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam H","family":"Beauchamp","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Montreal, Canada & CHU Sainte-Justine Azrieli Research Center , Montreal, Quebec , H3T 1C5","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco Veterans Affairs Healthcare System , San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia W","family":"Braga","sequence":"additional","affiliation":[{"name":"Psychiatry and Behavioural Science, SARAH Network of Rehabilitation Hospitals , Brasilia 70000-000 ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Ling","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, KK Women\u2019s and Children\u2019s Hospital, Duke-NUS Medical School , Singapore, Singapore 229 899"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3357-6490","authenticated-orcid":false,"given":"Anthony","family":"Figaji","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Cape Town , Cape Town 7925 ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Giza","sequence":"additional","affiliation":[{"name":"Division of Paediatric Neurology, Departments of Paediatrics and Neurosurgery, UCLA Brain Injury Research Center, University of California , Los Angeles, CA 90095-6901 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3228-9692","authenticated-orcid":false,"given":"David K","family":"Menon","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Cambridge , Cambridge CB2 0QQ 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