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Updated: Feb 10, 2026
A Novel Model of Mild Traumatic Brain Injury for Juvenile Rats
Published on: December 8, 2014
Evaluation of management and guideline adherence in children with mild traumatic brain injury
Merel C Broers1, Jikke-Mien F Niermeijer2, Irene A W Kotsopoulos3
1a Department of Paediatric Neurology , Erasmus University Hospital - Sophia Children's Hospital , Rotterdam , The Netherlands.
Insights
Pediatric mild traumatic brain injury (MTBI) management in Dutch emergency departments shows low guideline adherence. Physicians frequently admit children instead of performing CT scans, contrary to recommendations.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma Management
- Clinical Guideline Implementation
Background:
- Mild traumatic brain injury (MTBI) is common in children presenting to emergency departments.
- Effective management and adherence to clinical guidelines are crucial for optimal pediatric MTBI care.
- Variations in clinical practice can impact patient outcomes and resource utilization.
Purpose of the Study:
- To evaluate the current management practices for pediatric MTBI in Dutch emergency departments.
- To assess adherence to national MTBI guidelines among healthcare providers.
- To identify variations in management and guideline adherence across different hospitals.
Main Methods:
- A multicenter cohort study included 563 children under 18 with MTBI presenting within 24 hours of trauma.
- Data were collected on computed tomography (CT) scan rates and hospital admission rates.
- Guideline adherence was calculated as the percentage of patients managed according to recommendations.
Main Results:
- Hospital admission (49.2%) was more frequent than CT scans (30.9%) for pediatric MTBI.
- National guideline adherence was suboptimal, with only 49.7% of patients correctly managed.
- Significant overuse of hospital admission (35%) and underuse of CT (40.1%) were observed, with considerable inter-hospital variation.
Conclusions:
- Dutch emergency departments exhibit a preference for hospital admission over CT scans for pediatric MTBI, diverging from national guideline recommendations.
- Substantial variation in management and guideline adherence exists across hospitals, indicating a need for improved standardization.
- Further research and targeted interventions are necessary to enhance evidence-based care for children with MTBI.
Aim:
To evaluate the management and guideline adherence in children with mild traumatic brain injury (MTBI) in emergency departments (ED) in the Netherlands.
Methods:
A multicentre cohort study was conducted, including children younger than 18 years with MTBI who presented within 24 hours after trauma in the ED of hospitals in the southwest region of the Netherlands, in 2014. Primary outcome measures for management were percentages of performed computed tomography (CT) scans and hospital admissions. Guideline adherence was defined as percentages of correctly following the guideline. Secondary outcome measures were differences in management and guideline adherence between hospitals.
Results:
About 563 patients were analysed. Hospital admission was the most frequently performed management type (49.2% hospital admission vs. 30.9% CT). In only 49.7% of patients, the guideline was followed correctly. A substantial overuse of hospital admission (35%) and underuse of CT (40.1%) were found. Percentages of hospital admission and CT varied between 39.4-55.6% and 23.3-44.1%, respectively, across hospitals. Percentages of correctly following the guideline varied between 39.2-64.9% across hospitals.
Conclusion:
These findings suggest that physicians in the participating hospitals prefer hospital admission of children with MTBI instead of CT despite the current recommendations of the national MTBI guideline in the Netherlands.
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