{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:59:02Z","timestamp":1781632742306,"version":"3.54.5"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Traumatic brain injury (TBI) resulting from road traffic accidents (RTAs) is a leading cause of morbidity in children globally. However, paediatric TBI outcomes are understudied in Southeast Asia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine functional outcomes and associated factors among school-aged children with RTA-related TBI in Malaysia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study analysed medical records of 542 children aged 7\u201317 years with first-time TBI from RTAs. Data on sociodemographics, injury characteristics, complications, and outcomes were collected. The subjects\u2019 reports were grouped into three categories for analyses: young children (7\u20139-year-olds), adolescents (10\u201314-year-olds) and older adolescents (15\u201317-year-olds). Functional status was assessed using the Glasgow Outcome Scale\u2013Extended for Paediatrics (GOS-E Peds), and reported as good (category 1 and 2) or poor (category 3\u20138) outcomes. Descriptive statistics and multivariate logistic regression were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The majority of children were male (81.5%) with a mean age of 14.3 years. Motorcycles were the predominant accident mode (76.0%) especially among adolescents and older adolescents. The mean duration between the RTAs and report review was 20.7\u2009\u00b1\u200914.9 months. Only 27.5% of the children achieved good functional outcomes. Young children had the highest rate of recovery (34.5%), though not statistically significant. Among older adolescents, mild TBI significantly increased the odds of a good outcome (OR=2.5; 95% CI: 1.29\u20134.83;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007), while tracheostomy was strongly associated with poor outcomes (OR=7.02; 95% CI: 2.06\u201323.93;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Despite high rate of return to education, a significant proportion of children faced academic challenges post-brain injury.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Motorcycles remain the primary mode of RTA-related TBI among Malaysian children, particularly among adolescents. There was no significant difference in outcomes between the three age groups, although the young children had the highest rate of recovery. A substantial proportion of the children experience ongoing functional and academic difficulties despite returning to school. This highlights the need for coordinated clinical, educational, and policy responses in settings with limited paediatric rehabilitation infrastructure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351136","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:33:22Z","timestamp":1781631202000},"page":"e0351136","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of school-aged children following traumatic brain injury from road traffic accidents in Malaysia: A retrospective study"],"prefix":"10.1371","volume":"21","author":[{"given":"Esther","family":"Jimbih","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4012-1873","authenticated-orcid":true,"given":"Mazlina","family":"Mazlan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ria","family":"Waran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicknes","family":"Waran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"pone.0351136.ref001","doi-asserted-by":"crossref","DOI":"10.1016\/j.wneu.2016.03.045","article-title":"Epidemiology of global pediatric traumatic brain injury: Qualitative review","volume":"91","author":"MC Dewan","year":"2016","journal-title":"World Neurosurg"},{"key":"pone.0351136.ref002","author":"World Health Organization","year":"2023"},{"key":"pone.0351136.ref003","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s12887-016-0590-1","article-title":"The epidemiology of childhood brain injury in the state of Selangor and Federal Territory of Kuala Lumpur, Malaysia","volume":"16","author":"EL Tay","year":"2016","journal-title":"BMC Pediatr"},{"issue":"2","key":"pone.0351136.ref004","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S0387-7604(03)00102-5","article-title":"Clinical disorders of brain plasticity","volume":"26","author":"MV Johnston","year":"2004","journal-title":"Brain Dev"},{"issue":"1","key":"pone.0351136.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.braindev.2008.03.014","article-title":"Plasticity and injury in the developing brain","volume":"31","author":"MV Johnston","year":"2009","journal-title":"Brain Dev"},{"key":"pone.0351136.ref006","doi-asserted-by":"crossref","DOI":"10.5772\/intechopen.71344","article-title":"Age-dependent responses following traumatic brain injury","volume-title":"IntechOpen","author":"T Brickler","year":"2018"},{"issue":"7","key":"pone.0351136.ref007","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1093\/jpepsy\/jsn006","article-title":"Outcome and predictors of functional recovery 5 years following pediatric traumatic brain injury (TBI)","volume":"33","author":"C Catroppa","year":"2008","journal-title":"J Pediatr Psychol"},{"issue":"6","key":"pone.0351136.ref008","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1177\/0883073808314161","article-title":"Brain lesions and IQ: Recovery versus decline depends on age of onset","volume":"23","author":"J Duval","year":"2008","journal-title":"J Child Neurol"},{"issue":"4","key":"pone.0351136.ref009","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1097\/PCC.0000000000002575","article-title":"Traumatic Brain Injury Outcomes in 10 Asian Pediatric ICUs: A Pediatric Acute and Critical Care Medicine Asian Network Retrospective Study","volume":"22","author":"S-L Chong","year":"2021","journal-title":"Pediatr Crit Care Med"},{"issue":"11","key":"pone.0351136.ref010","doi-asserted-by":"crossref","first-page":"3197","DOI":"10.1007\/s00701-023-05741-0","article-title":"A multicenter observational study on outcomes of moderate and severe pediatric traumatic brain injuries-time to reappraise thresholds for treatment","volume":"165","author":"SK Qadri","year":"2023","journal-title":"Acta Neurochir (Wien)"},{"issue":"1","key":"pone.0351136.ref011","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1089\/neur.2025.0002","article-title":"Clinical characteristics and outcomes of pediatric traumatic brain injury patients in a tertiary regional trauma center in the Philippines","volume":"6","author":"MV Bayhon","year":"2025","journal-title":"Neurotrauma Rep"},{"issue":"3","key":"pone.0351136.ref012","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1054\/jocn.2001.1047","article-title":"Outcome of children with traumatic brain injury in rural Malaysia","volume":"9","author":"N Kumaraswamy","year":"2002","journal-title":"J Clin Neurosci"},{"issue":"3","key":"pone.0351136.ref013","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/S1015-9584(09)60334-1","article-title":"Persistence of cognitive deficits following paediatric head injury without professional rehabilitation in rural East Coast Malaysia","volume":"28","author":"JM Abdullah","year":"2005","journal-title":"Asian J Surg"},{"issue":"4","key":"pone.0351136.ref014","first-page":"25","article-title":"Prognostic factors of severe traumatic brain injury outcome in children aged 2-16 years at a major neurosurgical referral centre","volume":"16","author":"CH Kan","year":"2009","journal-title":"Malays J Med Sci"},{"issue":"9","key":"pone.0351136.ref015","article-title":"Outcome of 1939 traumatic brain injury patients from road traffic accidents: Findings from specialist medical reports in a low to middle income country (LMIC)","volume":"18","author":"J Teh","year":"2023","journal-title":"PLoS One"},{"key":"pone.0351136.ref016"},{"issue":"6","key":"pone.0351136.ref017","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1089\/neu.2011.2272","article-title":"Validity of a pediatric version of the Glasgow Outcome Scale-Extended","volume":"29","author":"SR Beers","year":"2012","journal-title":"J Neurotrauma"},{"key":"pone.0351136.ref018"},{"issue":"4","key":"pone.0351136.ref019","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.3171\/2017.10.JNS17352","article-title":"Estimating the global incidence of traumatic brain injury","volume":"130","author":"MC Dewan","year":"2018","journal-title":"J Neurosurg"},{"key":"pone.0351136.ref020","author":"World Health Organization","year":"2015"},{"issue":"2","key":"pone.0351136.ref021","doi-asserted-by":"crossref","first-page":"82","DOI":"10.2176\/nmc.ra.2016-0191","article-title":"Pediatric traumatic brain injury: Characteristic features, diagnosis, and management","volume":"57","author":"T Araki","year":"2017","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"4","key":"pone.0351136.ref022","doi-asserted-by":"crossref","first-page":"601","DOI":"10.4103\/jnrp.jnrp_381_17","article-title":"Impact of road traffic injury to pediatric traumatic brain injury in Southern Thailand","volume":"8","author":"T Tunthanathip","year":"2017","journal-title":"J Neurosci Rural Pract"},{"issue":"2","key":"pone.0351136.ref023","doi-asserted-by":"crossref","first-page":"121","DOI":"10.14203\/jissh.v10i2.181","article-title":"The phenomenon of underage motorbike riders in junior high school students: A critical review of juvenile delinquency","volume":"10","author":"AZ Lutfi","year":"2020","journal-title":"J Indones Soc Sci and Humanit"},{"key":"pone.0351136.ref024","doi-asserted-by":"crossref","first-page":"101569","DOI":"10.1016\/j.jth.2023.101569","article-title":"What leads underage teenagers to ride motorcycles without a permit? Utility vs parental permissiveness","volume":"29","author":"MH Nguyen","year":"2023","journal-title":"Journal of Transport & Health"},{"key":"pone.0351136.ref025","doi-asserted-by":"crossref","first-page":"012074","DOI":"10.1088\/1755-1315\/143\/1\/012074","article-title":"Analysis of child-related road traffic accidents in vietnam","volume":"143","author":"AT Vu","year":"2018","journal-title":"IOP Conf Ser: Earth Environ Sci"},{"key":"pone.0351136.ref026","doi-asserted-by":"crossref","first-page":"18757","DOI":"10.3402\/gha.v6i0.18757","article-title":"Road traffic injury among young people in Vietnam: Evidence from two rounds of national adolescent health surveys, 2004-2009","volume":"6","author":"LC Le","year":"2013","journal-title":"Glob Health Action"},{"issue":"3","key":"pone.0351136.ref027","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1080\/02699052.2024.2309252","article-title":"Further recommendations of the International Paediatric Brain Injury Society (IPBIS) for the post-acute rehabilitation of children with acquired brain injury","volume":"38","author":"MA Linden","year":"2024","journal-title":"Brain Inj"},{"issue":"4","key":"pone.0351136.ref028","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1097\/HTR.0000000000000859","article-title":"Return to school after traumatic brain injury: Description of implementation settings","volume":"38","author":"J Haarbauer-Krupa","year":"2023","journal-title":"J Head Trauma Rehabil"},{"issue":"4","key":"pone.0351136.ref029","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1046\/j.1440-1754.1998.00239.x","article-title":"Outcome of closed head injury in Malaysian children: Neurocognitive and behavioural sequelae","volume":"34","author":"LC Ong","year":"1998","journal-title":"J Paediatr Child Health"},{"key":"pone.0351136.ref030","doi-asserted-by":"crossref","first-page":"751736","DOI":"10.3389\/fneur.2021.751736","article-title":"A Systematic scoping review of new attention problems following traumatic brain injury in children","volume":"12","author":"S Stojanovski","year":"2021","journal-title":"Front Neurol"},{"key":"pone.0351136.ref031","doi-asserted-by":"crossref","first-page":"872469","DOI":"10.3389\/fneur.2022.872469","article-title":"Predictors of functional school outcome in children with pediatric acquired brain injury","volume":"13","author":"J Stubberud","year":"2022","journal-title":"Front Neurol"},{"issue":"6","key":"pone.0351136.ref032","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1159\/000028956","article-title":"Recovery of intellectual ability following traumatic brain injury in childhood: Impact of injury severity and age at injury","volume":"32","author":"V Anderson","year":"2000","journal-title":"Pediatr Neurosurg"},{"issue":"1","key":"pone.0351136.ref033","first-page":"10","article-title":"Profile of pediatric traumatic brain injury at the Dr. Soetomo General Hospital, Surabaya, Indonesia","volume":"6","author":"JN Fauziyah","year":"2023","journal-title":"Indonesian Journal of Neurosurgery"},{"key":"pone.0351136.ref034","article-title":"Children with learning disabilities in Malaysia","author":"MA Dzulkifli","year":"2023","journal-title":"IntechOpen"},{"key":"pone.0351136.ref035","first-page":"1","article-title":"Special education for children with disabilities: A review of the current policy and practice in Malaysia","volume":"25","author":"SM Baqutayan","year":"2016","journal-title":"Journal of Advanced Review on Scientific Research"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351136","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:33:28Z","timestamp":1781631208000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351136"}},"subtitle":[],"editor":[{"given":"Nik Hisamuddin","family":"Nik Ab. Rahman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,16]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0351136","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,16]]}}}