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Purpose <p>To assess age-stratified differences in neurosurgical outcomes following pediatric traumatic brain injury (TBI) in a resource-limited setting, using World Health Organization-defined developmental categories.</p> Methods <p>A retrospective review was conducted of pediatric TBI cases requiring neurosurgery at a tertiary hospital in La Paz, Bolivia (2019–2023). Primary outcomes included mortality and postoperative complications. Secondary outcomes were admission-to-surgery time, 30-day reoperation/readmission rates, and hospital length of stay (LOS).</p> Results <p>A total of 165 cases were identified with a median age of 4.7&#xa0;years (IQR 1.3–8.3). Infants had the highest rates of postoperative complications (44%) and reoperations (28%), significantly greater than older children (<i>p</i> &lt; 0.01). Infants experienced longer admission-to-surgery delays (median 3 vs. 1&#xa0;day, <i>p</i> &lt; 0.001) and nearly double the LOS (median 21 vs. 9&#xa0;days, <i>p</i> &lt; 0.001). Children aged 6–16&#xa0;years more frequently had focal injuries, typically underwent surgery within 1 day, and showed favorable short-term outcomes. Overall, 30‑day mortality was 4% (<i>n</i> = 6), with four deaths within 48&#xa0;h postoperatively. While overall 30-day survival (96%) did not differ by age (log-rank <i>p</i> = 0.45), reoperation-free survival varied significantly (<i>χ</i><sup>2</sup> = 15.3, <i>p</i> &lt; 0.01). Overall, 12% required reoperation by 30&#xa0;days, primarily driven by infants (28% vs. 7% in older children; <i>p</i> = 0.02).</p> Conclusion <p>Younger age, particularly infancy, was associated with higher surgical complexity, delays in intervention, and increased complications and reoperations, despite similar survival. Age-specific clinical protocols and early resource prioritization are essential to improve pediatric TBI outcomes in resource-limited environments.</p>

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Age-stratified neurosurgical outcomes for traumatic brain injury in a pediatric neurosurgical cohort in La Paz, Bolivia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月17日

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  • Caleigh S. Roach,
  • Jacob J. Shawwa,
  • Connor Nee,
  • Shreyas Chetan,
  • George Dong,
  • Anthony Rios,
  • Jorge Daniel Brun,
  • Jorge David Brun,
  • Victor M. Lu

摘要

Purpose

To assess age-stratified differences in neurosurgical outcomes following pediatric traumatic brain injury (TBI) in a resource-limited setting, using World Health Organization-defined developmental categories.

Methods

A retrospective review was conducted of pediatric TBI cases requiring neurosurgery at a tertiary hospital in La Paz, Bolivia (2019–2023). Primary outcomes included mortality and postoperative complications. Secondary outcomes were admission-to-surgery time, 30-day reoperation/readmission rates, and hospital length of stay (LOS).

Results

A total of 165 cases were identified with a median age of 4.7 years (IQR 1.3–8.3). Infants had the highest rates of postoperative complications (44%) and reoperations (28%), significantly greater than older children (p < 0.01). Infants experienced longer admission-to-surgery delays (median 3 vs. 1 day, p < 0.001) and nearly double the LOS (median 21 vs. 9 days, p < 0.001). Children aged 6–16 years more frequently had focal injuries, typically underwent surgery within 1 day, and showed favorable short-term outcomes. Overall, 30‑day mortality was 4% (n = 6), with four deaths within 48 h postoperatively. While overall 30-day survival (96%) did not differ by age (log-rank p = 0.45), reoperation-free survival varied significantly (χ2 = 15.3, p < 0.01). Overall, 12% required reoperation by 30 days, primarily driven by infants (28% vs. 7% in older children; p = 0.02).

Conclusion

Younger age, particularly infancy, was associated with higher surgical complexity, delays in intervention, and increased complications and reoperations, despite similar survival. Age-specific clinical protocols and early resource prioritization are essential to improve pediatric TBI outcomes in resource-limited environments.