Pediatric Traumatic Brain Injury in Northwest Ethiopia: Epidemiology, Surgical Management, and Rural-Urban Disparities at a Tertiary Referral Center.

Abstract

Pediatric traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide, with low- and middle-income countries disproportionately affected. Evidence on regional injury patterns, surgical management, and rural-urban disparities in Ethiopia is limited. This study aimed to describe the epidemiology, management, and short-term outcomes of pediatric TBI at a tertiary referral center in Northwest Ethiopia, with a focus on rural-urban differences. A retrospective cohort study was conducted at the University of Gondar Comprehensive Specialized Hospital. All pediatric patients (≤18 years) presenting with TBI between September 1, 2022, and September 30, 2025, were included. Demographic, clinical, imaging, and surgical data were extracted from medical records. Patients were categorized by residence (rural vs. urban). Primary measures included rates of surgical procedures, discharge status on the Glasgow Outcome Scale (GOS), and complications. Multivariable logistic regression identified independent predictors of surgical intervention. A total of 224 patients were included (median age 8 years, IQR 4-12; 73% male; 78% rural). Falls were the predominant mechanism of injury (63%), followed by assault (14%) and road traffic accidents (9%). Mild TBI (GCS 14-15) occurred in 76% of patients, moderate TBI in 19%, and severe TBI in 5%. CT scanning was performed in 41% of patients. Skull fractures were identified in 75%, of which 43% were depressed fractures. Overall, 50% underwent surgical intervention, most commonly elevation of depressed skull fracture (87%). Rural patients were more likely to sustain high-height falls (88% vs. 27%), have skull fractures (74% vs. 42%), and undergo surgery (57% vs. 24%) compared with urban patients (all p < 0.05). Postoperative complications occurred in 18% of surgical patients, predominantly surgical site infection or meningitis. Good recovery (GOS 5) was achieved in 83% of patients, and mortality was 1%. In multivariable analysis, skull fracture (aOR 7.37, 95% CI 3.89-13.98; p < 0.001) and rural residence (aOR 2.74, 95% CI 1.19-6.28; p = 0.018) were independent predictors of surgical intervention. Pediatric TBI in Northwest Ethiopia is predominantly fall-related, disproportionately affects rural children, and frequently requires surgical management. Skull fracture and rural residence are strong predictors of operative intervention. Despite delayed presentation and limited imaging, short-term outcomes are favorable. These findings highlight the need for region-specific injury prevention strategies and strengthened trauma care pathways to reduce disparities in pediatric neurotrauma outcomes.