{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:24:04Z","timestamp":1785324244183,"version":"3.55.0"},"reference-count":54,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T00:00:00Z","timestamp":1611187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CMRPG3K0801"],"award-info":[{"award-number":["CMRPG3K0801"]}],"id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["109-2622-B-182A-001"],"award-info":[{"award-number":["109-2622-B-182A-001"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Traumatic brain injury (TBI) is the leading cause of mortality in children. There are few studies focused on school-aged children with TBI. We conducted this study to identify the early predictors of in-hospital mortality in school-aged children with severe TBI. In this 10 year observational cohort study, a total of 550 children aged 7\u201318 years with TBI were enrolled. Compared with mild\/moderate TBI, children with severe TBI were older; more commonly had injury mechanisms of traffic accidents; and more neuroimage findings of subarachnoid hemorrhage (SAH), subdural hemorrhage (SDH), parenchymal hemorrhage, cerebral edema, and less epidural hemorrhage (EDH). The in-hospital mortality rate of children with severe TBI in our study was 23%. Multivariate analysis showed that falls, being struck by objects, motor component of Glasgow coma scale (mGCS), early coagulopathy, and SAH were independent predictors of in-hospital mortality. We concluded that school-aged children with severe TBI had a high mortality rate. Clinical characteristics including injury mechanisms of falls and being struck, a lower initial mGCS, early coagulopathy, and SAH are predictive of in-hospital mortality.<\/jats:p>","DOI":"10.3390\/brainsci11020136","type":"journal-article","created":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T09:49:21Z","timestamp":1611222561000},"page":"136","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury"],"prefix":"10.3390","volume":"11","author":[{"given":"Chih-Chi","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl P. C.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Hung","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2564-8431","authenticated-orcid":false,"given":"Yu-Wei","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, School of Medicine, Chang Gung University, 259, Sec1, WenHua First Road, Taoyuan 333, Taiwan"},{"name":"Healthy Aging Research Center, Chang Gung University, 259, Sec1, WenHua First Road, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2146-6040","authenticated-orcid":false,"given":"Chia-Ying","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Hung","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.ejpn.2019.01.009","article-title":"Incidence and mortality of moderate and severe traumatic brain injury in children: A ten year population-based cohort study in Norway","volume":"23","author":"Olsen","year":"2019","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1089\/neu.2014.3801","article-title":"Predicting Outcome after Pediatric Traumatic Brain Injury by Early Magnetic Resonance Imaging Lesion Location and Volume","volume":"33","author":"Smitherman","year":"2016","journal-title":"J. Neurotrauma"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2468","DOI":"10.1056\/NEJMsr1804754","article-title":"The Major Causes of Death in Children and Adolescents in the United States","volume":"379","author":"Cunningham","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.wneu.2016.03.045","article-title":"Epidemiology of Global Pediatric Traumatic Brain Injury: Qualitative Review","volume":"91","author":"Dewan","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_5","unstructured":"(2021, January 20). Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. PsycEXTRA Dataset, Available online: https:\/\/www.cdc.gov\/traumaticbraininjury\/data\/tbi-edhd.html."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/S1474-4422(13)70073-5","article-title":"Mortality in severe traumatic brain injury","volume":"12","author":"Blanot","year":"2013","journal-title":"Lancet Neurol."},{"key":"ref_7","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":"Araki","year":"2017","journal-title":"Neurol. Med. Chir."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Chen, C.-C., Hsieh, P.-C., Chen, C.P.C., Hsieh, Y.-W., Chung, C.-Y., Lin, K.-L., and Prevention, Protection Against Child Abuse, Neglect (PCHAN) Study Group (2019). Clinical Characteristics and Predictors of Poor Hospital Discharge Outcome for Young Children with Abusive Head Trauma. J. Clin. Med. Res., 8.","DOI":"10.3390\/jcm8030390"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1136\/archdischild-2015-308424","article-title":"Epidemiology of children with head injury: A national overview","volume":"101","author":"Trefan","year":"2016","journal-title":"Arch. Dis. Child."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6609a1","article-title":"Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths United States, 2007 and 2013","volume":"66","author":"Taylor","year":"2017","journal-title":"MMWR Surveill. Summ."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1227\/NEU.0b013e3181fa7049","article-title":"Mortality in children with severe head trauma: Predictive factors and proposal for a new predictive scale","volume":"67","author":"Blanot","year":"2010","journal-title":"Neurosurgery"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"29","DOI":"10.4103\/0974-2700.76831","article-title":"Isolated traumatic head injury in children: Analysis of 276 observations","volume":"4","author":"Bahloul","year":"2011","journal-title":"J. Emerg. Trauma Shock"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1542\/peds.2003-1020-L","article-title":"A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury","volume":"114","author":"Keenan","year":"2004","journal-title":"Pediatrics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/00005373-199907000-00008","article-title":"Severe Head Injury in Children","volume":"47","author":"Feickert","year":"1999","journal-title":"J. Trauma"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1136\/jnnp.2007.135178","article-title":"Observational approach to subjects with mild-to-moderate head injury and initial non-neurosurgical lesions","volume":"79","author":"Fabbri","year":"2008","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Heather, N.L., Derraik, J.G.B., Beca, J., Hofman, P.L., Dansey, R., Hamill, J., and Cutfield, W.S. (2013). Glasgow Coma Scale and outcomes after structural traumatic head injury in early childhood. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0082245"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1093\/brain\/awn293","article-title":"Childhood brain insult: Can age at insult help us predict outcome?","volume":"132","author":"Anderson","year":"2009","journal-title":"Brain"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1097\/00003246-200103000-00011","article-title":"Predictors of outcome in severely head-injured children","volume":"29","author":"White","year":"2001","journal-title":"Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1097\/SHK.0000000000000151","article-title":"Coagulopathy after severe pediatric trauma: A review","volume":"41","author":"Christiaans","year":"2014","journal-title":"Shock"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/TA.0000000000001060","article-title":"The impact of acute coagulopathy on mortality in pediatric trauma patients","volume":"81","author":"Strumwasser","year":"2016","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.resuscitation.2007.07.007","article-title":"PENTA study group Assessing the level of consciousness in children: A plea for the Glasgow Coma Motor subscore","volume":"76","author":"Sabbe","year":"2008","journal-title":"Resuscitation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1097\/TA.0000000000000095","article-title":"Blood component transfusion increases the risk of death in children with traumatic brain injury","volume":"76","author":"Acker","year":"2014","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/PCC.0b013e3182192c30","article-title":"Relationship between hyperglycemia and outcome in children with severe traumatic brain injury","volume":"13","author":"Smith","year":"2012","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"719476","DOI":"10.1155\/2015\/719476","article-title":"Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay","volume":"2015","author":"Chong","year":"2015","journal-title":"Int. J. Endocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1007\/s00381-018-3989-1","article-title":"The role of coagulopathy on clinical outcome following traumatic brain injury in children: Analysis of 66 consecutive cases in a single center institution","volume":"34","author":"Furlanetti","year":"2018","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1016\/j.injury.2010.01.021","article-title":"Epidemiology of traumatic epidural hematoma in young age","volume":"41","author":"Irie","year":"2010","journal-title":"Injury"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1159\/000056002","article-title":"Prognostic factors in children with severe diffuse brain injuries: A study of 74 patients","volume":"34","author":"Pillai","year":"2001","journal-title":"Pediatr. Neurosurg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s12028-014-9986-7","article-title":"Subarachnoid hemorrhage prevalence and its association with short-term outcome in pediatric severe traumatic brain injury","volume":"21","author":"Hochstadter","year":"2014","journal-title":"Neurocrit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Shao, J., Zhu, H., Yao, H., Stallones, L., Yeates, K., Wheeler, K., and Xiang, H. (2012). Characteristics and Trends of Pediatric Traumatic Brain Injuries Treated at a Large Pediatric Medical Center in China, 2002\u20132011. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0051634"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/TA.0000000000000300","article-title":"Glasgow motor scale alone is equivalent to Glasgow Coma Scale at identifying children at risk for serious traumatic brain injury","volume":"77","author":"Acker","year":"2014","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_31","first-page":"S876","article-title":"Part 14: Pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"122","author":"Kleinman","year":"2010","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/SHK.0b013e31828e08cb","article-title":"Early coagulopathy is an independent predictor of mortality in children after severe trauma","volume":"39","author":"Whittaker","year":"2013","journal-title":"Shock"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"688","DOI":"10.3171\/jns.1990.73.5.0688","article-title":"Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank","volume":"73","author":"Eisenberg","year":"1990","journal-title":"J. Neurosurg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"170","DOI":"10.3171\/jns.1981.54.2.0170","article-title":"Diffuse cerebral swelling following head injuries in children: The syndrome of \u201cmalignant brain edema\u201d","volume":"54","author":"Bruce","year":"1981","journal-title":"J. Neurosurg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1080\/03610730701239004","article-title":"Population inference with mortality and attrition in longitudinal studies on aging: A two-stage multiple imputation method","volume":"33","author":"Harel","year":"2007","journal-title":"Exp. Aging Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s40001-015-0159-8","article-title":"TraumaRegister DGU Increased in-hospital mortality following severe head injury in young children: Results from a nationwide trauma registry","volume":"20","author":"Lichte","year":"2015","journal-title":"Eur. J. Med. Res."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Suttipongkaset, P., Chaikittisilpa, N., Vavilala, M.S., Lele, A.V., Watanitanon, A., Chandee, T., and Krishnamoorthy, V. (2018). Blood Pressure Thresholds and Mortality in Pediatric Traumatic Brain Injury. Pediatrics, 142.","DOI":"10.1542\/peds.2018-0594"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1007\/s12028-017-0480-x","article-title":"Age and Mortality in Pediatric Severe Traumatic Brain Injury: Results from an International Study","volume":"28","author":"Sarnaik","year":"2018","journal-title":"Neurocrit. Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"S468","DOI":"10.1097\/00003246-200211001-00012","article-title":"Multiple trauma in children: Critical care overview","volume":"30","author":"Wetzel","year":"2002","journal-title":"Crit. Care Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1016\/j.ajem.2010.06.002","article-title":"Hypothermia is associated with poor outcome in pediatric trauma patients","volume":"29","author":"Sundberg","year":"2011","journal-title":"Am. J. Emerg. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1097\/TA.0000000000001280","article-title":"Epidemiology and outcomes of children with accidental hypothermia: A propensity-matched study","volume":"82","author":"Totapally","year":"2017","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/01.PCC.0000123545.69133.C3","article-title":"Cerebral autoregulation in pediatric traumatic brain injury","volume":"5","author":"Vavilala","year":"2004","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S0022-3476(05)80426-3","article-title":"Limitations of the Glasgow Coma Scale in predicting outcome in children with traumatic brain injury","volume":"120","author":"Theodorou","year":"1992","journal-title":"J. Pediatr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.annemergmed.2016.11.032","article-title":"Predictive Utility of the Total Glasgow Coma Scale Versus the Motor Component of the Glasgow Coma Scale for Identification of Patients with Serious Traumatic Injuries","volume":"70","author":"Chou","year":"2017","journal-title":"Ann. Emerg. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/00005373-198804000-00017","article-title":"Hyperglycemia is Not a Poor Prognostic Sign in Head-Injured Children","volume":"28","author":"Parish","year":"1988","journal-title":"J. Trauma"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1080\/02699052.2016.1264629","article-title":"The impact of early hyperglycaemia on children with traumatic brain injury","volume":"31","author":"Fu","year":"2017","journal-title":"Brain Inj."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1213\/ane.0b013e31818a6f32","article-title":"Incidence and risk factors for perioperative hyperglycemia in children with traumatic brain injury","volume":"108","author":"Sharma","year":"2009","journal-title":"Anesth. Analg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13054-017-1883-y","article-title":"Glycaemic control targets after traumatic brain injury: A systematic review and meta-analysis","volume":"22","author":"Hermanides","year":"2018","journal-title":"Crit. Care"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1097\/PEC.0b013e31819a8966","article-title":"Traumatic epidural hematomas in children and adolescents: Outcome analysis in 39 consecutive unselected cases","volume":"25","author":"Gerlach","year":"2009","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1097\/PEC.0000000000001321","article-title":"Prediction of Poor Prognosis After Severe Head Injury in Children Using Logistic Regression","volume":"34","author":"Ichikawa","year":"2018","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1182\/blood-2016-01-636423","article-title":"Advances in the understanding of trauma-induced coagulopathy","volume":"128","author":"Chang","year":"2016","journal-title":"Blood"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/s12974-016-0555-1","article-title":"The effect of concomitant peripheral injury on traumatic brain injury pathobiology and outcome","volume":"13","author":"McDonald","year":"2016","journal-title":"J. Neuroinflamm."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jclinepi.2019.02.016","article-title":"The proportion of missing data should not be used to guide decisions on multiple imputation","volume":"110","author":"Hughes","year":"2019","journal-title":"J. Clin. Epidemiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e13081","DOI":"10.1097\/MD.0000000000013081","article-title":"Serum electrolyte imbalance and prognostic factors of postoperative death in adult traumatic brain injury patients: A prospective cohort study","volume":"97","author":"Saringkarinkul","year":"2018","journal-title":"Medicine"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/2\/136\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:13:34Z","timestamp":1760159614000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/2\/136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,21]]},"references-count":54,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["brainsci11020136"],"URL":"https:\/\/doi.org\/10.3390\/brainsci11020136","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,21]]}}}