Pediatric neurotrauma in Kathmandu, Nepal: implications for injury management and control.
OBJECTIVE
There is a scarcity of data regarding childhood neurological injuries in developing countries such as Nepal. The epidemiology of acute pediatric neurotrauma in Kathmandu was studied to assess the implications of these data for injury prevention programs.


METHODS
The clinical records of patients <or=18 years who presented to Tribhuvan University Teaching Hospital between April 1, 2001 and April 1, 2004 with acute neurological trauma and were subsequently admitted to hospital were retrospectively reviewed. A standard proforma was used to collect information on patient demographics, the nature and etiology of the injuries, their acute management, and outcomes.


CONCLUSIONS
Four hundred sixteen injured children were admitted to hospital, and the charts for 352 (85%) were available for review. Spinal injuries were relatively rare (4%) compared to head injuries (96%). Falls were the most common cause of injuries (61%). It took significantly longer (p<0.001) for children injured in rural Nepal (62%) to obtain neurosurgical care (30.1 h) than those injured within Kathmandu (7.1 h). A Glasgow Outcome Score of 5 was obtained for 96%, 76%, and 22% of patients with mild, moderate, or severe head injuries, respectively. Besides efforts to improve prehospital transport and acute management of these injuries, preventive measures that are applicable to the Nepalese scenario are urgently needed. Interventions should focus on health education programs directed at parents and children and upgrading of road safety measures. Neurological injuries must also be viewed in the context of the broader social issues in Nepal that contribute to injury.
Mukhida
Karim
K
Division of Neurosurgery, University of Toronto, Toronto, Canada. kmukhida@dal.ca
Sharma
Mohan R
MR
Shilpakar
Sushil K
SK
D000056:Accident Prevention / Q000379:methods*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000628:therapy; D016021:Epidemiologic Studies; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009390:Nepal / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000628:therapy; D013124:Spinal Injuries / Q000453:epidemiology / Q000628:therapy; D020196:Trauma, Nervous System / Q000453:epidemiology / Q000628:therapy