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

TL;DR

This study examines how age affects outcomes for children with traumatic brain injuries in Bolivia, finding that infants face higher surgical risks and complications.

Contribution

The study introduces age-stratified insights into pediatric TBI outcomes in a resource-limited setting using WHO developmental categories.

Findings

Infants had significantly higher postoperative complication and reoperation rates compared to older children.

Infants experienced longer delays in surgery and hospital stays compared to older children.

Children aged 6–16 years had more focal injuries and better short-term outcomes.

Abstract

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.

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).

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).

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.

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