Predictors of traumatic brain injury amongst secondary school students in England: A retrospective cohort study using electronic health records

Background: Traumatic brain injury (TBI) in children and adolescents is a leading cause of disability and mortality, with long-term health-related consequences. There is little evidence describing the children and adolescents most at risk of TBI. Objective: To identify the demographic and clinical predictors of TBI in secondary school-aged children in England. Participants and setting: Linked Clinical Practice Research Datalink and Hospital Episode Statistics Admitted Patient Care data were used to identify patients aged 11–18 years registered with a GP surgery in England between 2013 and 2021. Methods: Multivariable Cox regression was used to assess the association between demographic and clinical risk factors and time to medically attended TBI. Results: The analytical sample included 402,249 children, 2.3% of which had a TBI presenting to primary or hospital care when aged 11–18 years. In the fully adjusted model, increased risk of TBI was associated with being male; less socioeconomically deprived; having a history of fracture, abuse, depression, or previous TBI; having two or more previous GP visits, having more previous Emergency Department visits; and having fewer hospital admissions. Conclusion: Using a nationally representative dataset we were able to identify which children were most at risk of TBI in their secondary school years. TBI is often preventable and targeted interventions could be aimed at these children and their families.