The Association Between Transformational Leadership and Nurses' Clinical Performance in the Tabuk Health Cluster, Saudi Arabia.

Traumatic brain injury (TBI) affects an estimated 69 million individuals worldwide across all age groups () and is a leading cause of death and disability, making it a significant global health concern (; ). In the United States, there are approximately 2.8 million TBI-related emergency department visits each year, with children under the age of 18 accounting for a significant portion with over 812,000 visits (). Additionally, 23,000 children are hospitalized due to TBI, and more than 2,500 die from these injuries each year (). Pediatric TBI is particularly concerning due to the heightened vulnerability of the developing brain, which is more susceptible to injury. Moderate-to-severe TBIs in children can result in persistent motor, cognitive, and emotional impairments that significantly affect social development, academic performance, and overall quality of life (; ; ; ; ). These impairments can hinder developmental milestones and lead to long-term challenges for a child’s future health and well-being. Despite extensive research into potential therapeutics for alleviating TBI-induced deficits, no FDA-approved treatments currently exist (; ; ; Moschonas et al., 2024). The limited success of translating single-agent treatments into effective clinical practice highlights a critical gap and the need for the integration of more comprehensive, multi-faceted therapeutic strategies (; ). While some combinational therapies are under investigation, accelerating their development and integration could significantly enhance recovery and improve long-term outcomes (), particularly for vulnerable populations like children. One promising avenue for improving recovery after TBI involves targeting dopaminergic dysfunction, a well-documented consequence of injury that contributes to persistent motor, cognitive, and motivational deficits (). Across both clinical and preclinical studies, pharmacotherapies with dopaminergic activity, particularly those enhancing dopamine D receptor signaling, have demonstrated therapeutic potential. Pharmacological agents such as methylphenidate and bromocriptine improve arousal, attention, and executive function after TBI, underscoring the importance of dopaminergic pathway modulation for functional recovery (, , ; ; ; ; ; ).