Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge
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Updated: Oct 9, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Thomas M O'Lynnger1, Chevis N Shannon1, Truc M Le2
1Departments of 1 Neurological Surgery.
Insights
Implementing a standardized care protocol significantly improved outcomes for children with severe traumatic brain injury (TBI). This led to more favorable discharge dispositions and reduced mortality rates in pediatric critical care settings.
Area of Science:
- Pediatric Critical Care
- Neurotrauma Management
- Clinical Protocol Implementation
Background:
- Severe traumatic brain injury (TBI) in children poses significant challenges to critical care providers.
- Secondary brain injury, including cerebral ischemia and suboptimal cerebral blood flow, is a major concern.
- Standardized decision-making and interventions are crucial for optimizing TBI care.
Purpose of the Study:
- To evaluate the impact of a standardized care protocol on short-term outcomes in pediatric severe TBI patients.
- To compare discharge disposition and Glasgow Outcome Scale scores before and after protocol implementation.
- To assess changes in mortality rates following the introduction of a best-practice guideline protocol.
Main Methods:
- Retrospective pre- and postprotocol study of 128 pediatric patients with severe TBI (Glasgow Coma Scale score < 8).
- Data collected from a tertiary care center pediatric critical care unit between April 2008 and May 2014.
- Ordered logistic regression analysis used to assess outcomes, controlling for injury severity and clinical parameters.
Main Results:
- No significant demographic or injury severity differences between pre- and postprotocol groups (GCS mean 5.43 vs. 5.28).
- Postprotocol cohort showed an odds ratio of 4.0 for increasingly favorable outcomes (p = 0.007).
- Favorable discharge disposition increased from 36% to 69% (p = 0.002), and mortality decreased from 31% to 21% (p = 0.04).
Conclusions:
- Implementation of a standardized care protocol significantly improved discharge disposition in pediatric severe TBI patients.
- The standardized protocol led to a reduction in mortality rates for children with severe TBI.
- Best-practice guideline adherence in a standardized protocol enhances outcomes in pediatric neurocritical care.
Abstract:
OBJECT The goal of critical care in treating traumatic brain injury (TBI) is to reduce secondary brain injury by limiting cerebral ischemia and optimizing cerebral blood flow. The authors compared short-term outcomes as defined by discharge disposition and Glasgow Outcome Scale scores in children with TBI before and after the implementation of a protocol that standardized decision-making and interventions among neurosurgeons and pediatric intensivists. METHODS The authors performed a retrospective pre- and postprotocol study of 128 pediatric patients with severe TBI, as defined by Glasgow Coma Scale (GCS) scores < 8, admitted to a tertiary care center pediatric critical care unit between April 1, 2008, and May 31, 2014. The preprotocol group included 99 patients, and the postprotocol group included 29 patients. The primary outcome of interest was discharge disposition before and after protocol implementation, which took place on April 1, 2013. Ordered logistic regression was used to assess outcomes while accounting for injury severity and clinical parameters. Favorable discharge disposition included discharge home. Unfavorable discharge disposition included discharge to an inpatient facility or death. RESULTS Demographics were similar between the treatment periods, as was injury severity as assessed by GCS score (mean 5.43 preprotocol, mean 5.28 postprotocol; p = 0.67). The ordered logistic regression model demonstrated an odds ratio of 4.0 of increasingly favorable outcome in the postprotocol cohort (p = 0.007). Prior to protocol implementation, 63 patients (64%) had unfavorable discharge disposition and 36 patients (36%) had favorable discharge disposition. After protocol implementation, 9 patients (31%) had unfavorable disposition, while 20 patients (69%) had favorable disposition (p = 0.002). In the preprotocol group, 31 patients (31%) died while 6 patients (21%) died after protocol implementation (p = 0.04). CONCLUSIONS Discharge disposition and mortality rates in pediatric patients with severe TBI improved after implementation of a standardized protocol among caregivers based on best-practice guidelines.
