{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T09:19:42Z","timestamp":1781774382488,"version":"3.54.5"},"reference-count":30,"publisher":"BMJ","issue":"8","funder":[{"name":"Singapore SingHealth DUKE-NUS Paediatrics Academic Clinical Programme"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,6,29]]},"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aim to examine the mechanisms of head-injured children presenting to participating centres in the Pan Asian Trauma Outcomes Study (PATOS) and to evaluate the association between mechanism of injury and severe outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>We performed a retrospective review of medical records among emergency departments (EDs) of eight PATOS centres, from September 2014 \u2013 August 2015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We included children\u2009&lt;16 years old who presented within 24\u2009hours of head injury and were admitted for observation or required a computed tomography (CT) of the brain from the ED. We excluded children with known coagulopathies, neurological co-morbidities or prior neurosurgery. We reviewed the mechanism, intent, location and object involved in each injury, and the patients\u2019 physical findings on presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>Primary outcomes were death, endotracheal intubation or neurosurgical intervention. Secondary outcomes included hospital and ED length of stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>1438 children were analysed. 953 children (66.3%) were male and the median age was 5.0 years (IQR 1.0\u201310.0). Falls predominated especially among children younger than 2 years (82.9%), while road traffic injuries were more likely to occur among children 2 years and above compared with younger children (25.8% vs 11.1%). Centres from upper and lower middle-income countries were more likely to receive head injured children from road traffic collisions compared with those from high-income countries (51.4% and 40.9%, vs 10.9%, p&lt;0.0001) and attended to a greater proportion of children with severe outcomes (58.2% and 28.4%, vs 3.6%, p&lt;0.0001). After adjusting for age, gender, intent of injury and gross national income, traffic injuries (adjusted OR 2.183, 95%\u2009CI 1.448 to 3.293) were associated with severe outcomes, as compared with falls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among children with head injuries, traffic injuries are independently associated with death, endotracheal intubation and neurosurgery. This collaboration among Asian centres holds potential for future prospective childhood injury surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-015759","type":"journal-article","created":{"date-parts":[[2017,8,18]],"date-time":"2017-08-18T20:10:20Z","timestamp":1503087020000},"page":"e015759","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["A retrospective review of paediatric head injuries in Asia \u2013 a Pan Asian Trauma Outcomes Study (PATOS) collaboration"],"prefix":"10.1136","volume":"7","author":[{"given":"Shu-Ling","family":"Chong","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, KK Women\u2019s and Children\u2019s Hospital, Singapore, Singapore"},{"name":"Duke-NUS Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uzma Rahim","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indumathy","family":"Santhanam","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency Medicine, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, Tamilnadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Seok","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Dongguk University Ilsan Hospital, School of Medicine, Dongguk University, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Beijing Children's Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabariah Faizah","family":"Jamaluddin","sequence":"additional","affiliation":[{"name":"Department of Emergency and Trauma, Sungai Buloh Hospital, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quoc Ai","family":"Hoang Trong","sequence":"additional","affiliation":[{"name":"Department of Emergency, Hue Central Hospital, Hue, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su Yah","family":"Chew","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"},{"name":"Khoo Teck Puat-National Children\u2019s Medical Institute,, National University Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus Eng Hock","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Singapore General Hospital, Singapore"},{"name":"Health Services and Systems Research, Duke-NUS Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,8,18]]},"reference":[{"key":"2025121404295939000_7.8.e015759.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2013.04.016"},{"key":"2025121404295939000_7.8.e015759.2","doi-asserted-by":"crossref","first-page":"25366","DOI":"10.3402\/gha.v7.25366","article-title":"Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System Sites","volume":"7","author":"Streatfield","year":"2014","journal-title":"Glob Health Action"},{"key":"2025121404295939000_7.8.e015759.3","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1080\/15389588.2015.1066498","article-title":"Commentary: status of road safety in Asia","volume":"17","author":"Wismans","year":"2016","journal-title":"Traffic Inj Prev"},{"key":"2025121404295939000_7.8.e015759.4","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1016\/j.injury.2015.04.002","article-title":"Predictors for moderate to severe paediatric head injury derived from a surveillance registry in the emergency department","volume":"46","author":"Chong","year":"2015","journal-title":"Injury"},{"key":"2025121404295939000_7.8.e015759.5","doi-asserted-by":"crossref","first-page":"e133","DOI":"10.1016\/j.rehab.2016.07.298","article-title":"Academic outcome, participation and health-related quality of life following childhood severe traumatic brain injury: results of a prospective longitudinal study: the seven-year follow-up of the TGE cohort","volume":"59","author":"Chevignard","year":"2016","journal-title":"Ann Phys Rehabil Med"},{"key":"2025121404295939000_7.8.e015759.6","doi-asserted-by":"crossref","unstructured":"Treble-Barna A , Zang H , Zhang N , et al . 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