• S R Reid, J S Roesler, A M Gaichas, and A K Tsai.
• Pediatric Emergency Medicine, Children's Hospitals and Clinics, 345 N Smith Ave, St Paul, MN 55102, USA. krinandsam@aol.com
• Arch Pediat Adol Med. 2001 Jul 1;155(7):784-9.

ObjectivesTo determine the epidemiology of pediatric traumatic brain injury (TBI) in a midwestern state and to examine differences between metropolitan and nonmetropolitan residents.DesignPopulation-based case series.ParticipantsPatients aged 0-19 years sustaining TBI in 1993 that resulted in hospitalization or death.InterventionsNone.Main Outcome MeasuresIncidence, mortality and case-fatality rates, length of hospital stay, discharge status, and Glasgow Outcome Scale score.ResultsNine hundred seventy-seven patients met inclusion criteria. Incidence, mortality, and case-fatality rates were 73.5 per 100 000, 9.3 per 100 000, and 12.8 per 100, respectively. Higher median household incomes and percentages of adult high-school graduates in a patient's census block group correlated with lower incidence. Median length of stay was 2 days. Of those included in the study, 720 patients (74%) were discharged home with self-care. Three hundred fifty-seven patients met criteria for severe TBI; 346 (97%) were assigned Glasgow Outcome Scale scores, of which 161 (47%) had disabilities or died. Severe TBI was associated with nonmetropolitan residence, higher median household income, and certain injury mechanisms. Incidence was similar for metropolitan and nonmetropolitan residents. Median head-region Abbreviated Injury Score, Injury Severity Score, and mortality and case-fatality rates were higher for nonmetropolitan residents.ConclusionsThis study reports the lowest incidence of pediatric TBI that results in death or hospitalization to date. One half of severely injured patients suffered poor outcomes. A greater proportion of nonmetropolitan than metropolitan residents suffered severe TBI and had higher mortality and case-fatality rates.

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