Outcomes of school-aged children following traumatic brain injury from road traffic accidents in Malaysia: A retrospective study.

Jimbih E; Mazlan M; Waran R; Waran V · 2026 · PubMed Central

DOI: 10.1371/journal.pone.0351136

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Summary

This retrospective study addresses the under-researched area of pediatric traumatic brain injury (TBI) outcomes in Southeast Asia, specifically examining school-aged children in Malaysia who sustained TBI from road traffic accidents (RTAs). The research was motivated by the high prevalence of RTA-related TBI in low- and middle-income countries and the lack of recent data on pediatric outcomes in Malaysia, despite the critical impact of such injuries on cognitive, social, and educational development. The study analyzed medical records of 542 children aged 7–17 years with first-time TBI from RTAs over a ten-year period (2009–2019). Participants were categorized into three age groups: young children (7–9 years), adolescents (10–14 years), and older adolescents (15–17 years). Data on sociodemographics, injury characteristics, complications, and functional outcomes were extracted from specialist reports. Functional status was assessed using the Glasgow Outcome Scale–Extended for Paediatrics (GOS-E Peds), with outcomes classified as "good" (categories 1–2) or "poor" (categories 3–8). Statistical analyses included descriptive statistics and multivariate logistic regression, with the latter applied to the older adolescent group due to sufficient sample size. The results indicated that 81.5% of participants were male, and motorcycles were the predominant mode of accident (76.0%), particularly among adolescents and older adolescents. Only 27.5% of all children achieved good functional outcomes. Young children had the highest rate of good outcomes (34.5%), though this difference was not statistically significant across age groups. In older adolescents, mild TBI significantly increased the odds of a good outcome (OR=2.5; p=0.007), while tracheostomy was strongly associated with poor outcomes (OR=7.02; p=0.002). Despite high rates of return to education, a significant proportion of children faced academic challenges, including declining performance and transfers to special education. Common post-injury complaints included forgetfulness, headaches, and dizziness. The study concludes that motorcycles remain the primary cause of RTA-related TBI among Malaysian children, especially adolescents. Although young children showed the highest recovery rates, a substantial proportion of all age groups experienced ongoing functional and academic difficulties. The findings highlight the need for coordinated clinical, educational, and policy responses, particularly in settings with limited pediatric rehabilitation infrastructure. The high prevalence of underage motorcycle riding and the persistent academic deficits underscore the importance of targeted interventions and improved road safety measures for this vulnerable population.

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• demographic disparities