DESCRIPTION (provided by applicant): The incidence of traumatic brain injury (TBI) in Latin America is three times the international average. Worldwide, TBI is the leading cause of death and disability among children and adolescents. Mortality and morbidity due to non- neurological, secondary complications such as sepsis and pneumonia are high. There is little to no post-discharge rehabilitation for TBI, and follow-up care for these patients is rare. Treatment practices vary across centers and regions. Where resources allow, many centers use the Guidelines for the Acute Medical Management of TBI in Infants, Children, and Adolescents to guide their treatment decisions. Pilot data suggests that doing so may improve outcomes. There is an urgent need to conduct strong research about pediatric TBI in Latin America that can lead to diagnostics, treatment, and prevention. We propose to conduct a study of TBI in pediatric patients in Latin America. It will take place in five trauma centers; three in Argentina, one in Bolivia, and one in Ecuador. These centers represent the variation in resources available for treatment of TBI in Latin America. Our Specific Aims are: 1. In a randomized controlled trial, test the effect of a family-provided home care intervention on functional outcomes for pediatric patients who sustain moderate to severe TBI. 2. In a prospective, observational study, test the association between medical management and outcomes for pediatric patients with severe TBI. 3. In a prospective, observational study, test the association between resource availability and outcomes for pediatric patients with moderate to severe TBI. 4. Establish a registry of long-term, prospectively collected data about pediatric TBI in Latin America that can be used to generate strong scientific literature from which diagnostic, treatment, prognostic, and prevention guidelines - appropriate to resource-poor environments - can be derived. 5. Establish sustainable capacity in the Latin American Brain Injury Consortium (LABIC) to conduct ongoing research in pediatric populations with neurotrauma and other significant brain disorders. Our estimated sample is 720 acute care patients; we anticipate 65% will survive to discharge, and will collect outcomes data on approximately 420 patients (accounting for 10% loss to follow-up). We hypothesize that patients randomized to the home care intervention will have significantly better functional status than those who do not receive the intervention. We further hypothesize that outcome will be significantly associated with level of resources, and with medical management. PUBLIC HEALTH RELEVANCE: Traumatic brain injury (TBI) is of significant public health concern. Worldwide, it is the leading cause of death and disability among children and adolescents. Latin America has the highest incidence of intracranial injury in the world due to road traffic accidents and violence. The incidence of TBI in children in Latin America is almost three times higher than the international average. Rehabilitation for TBI is rare in most of Latin America - available only to the privileged or the employee-insured. Survivors are discharged to their families to live a life of disability, isolation, and stigma, with no follow-up care. The burden of illness is particularly poignant for pediatric TBI patients, as these children cannot return to school or engage in productive activities in their communities, but live many years completely dependent upon their families.

Traumatic brain injury (TBI) is of significant public health concern. Worldwide, it is the leading cause of death and disability among children and adolescents. Latin America has the highest incidence of intracranial injury in the world due to road traffic accidents and violence. The incidence of TBI in children in Latin America is almost three times higher than the international average. Rehabilitation for TBI is rare in most of Latin America - available only to the privileged or the employee-insured. Survivors are discharged to their families to live a life of disability, isolation, and stigma, with no follow-up care. The burden of illness is particularly poignant for pediatric TBI patients, as these children cannot return to school or engage in productive activities in their communities, but live many years completely dependent upon their families.