Abstract / Summary
Purpose: To characterize hospitalized children aged ≤72 months with traumatic head injury at a Serbian tertiary pediatric center, evaluate factors associated with severe clinical course as the primary patient-level outcome, and describe temporal patterns in hospitalization among head-injury presentations. Methods: This retrospective single-center study covered 2010–2025. Patient-level data were available for hospitalized children, while annual aggregate counts described head-injury presentations. Severe clinical course was defined as recorded GCS ≤ 8 on admission, surgical intensive care unit admission, and/or surgical intervention. Multivariable logistic regression evaluated associated factors, and quasi-binomial regression examined temporal changes in hospitalization proportions. Results: A cohort of 971 hospitalized children was analyzed. Over the study duration, a decrease in the absolute number of head injury evaluations was observed, whereas the proportion of hospitalizations increased from 11.6% to 58.0%. The predominant mechanism of injury was domestic falls from heights. Most children (98.2%) were managed conservatively. A severe clinical course was documented in 70 children (7.2%). Factors significantly associated with higher odds of a severe clinical course included infancy (age ≤ 12 months), ambulance transport, inter-institutional transfer, and traffic-related incidents. Conclusions: The distinctive finding was a rising hospitalization proportion despite fewer head-injury presentations. This describes changing service use rather than establishing an increase in injury severity or identifying avoidable admissions. The findings support evaluation of local admission and observation pathways and improved clinical documentation; the causes of the temporal trend require further study.