# 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.

## Key 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.