Applying Pediatric Brain Injury Guidelines at a Level I Adult/Pediatric Safety-Net Trauma Center.

Area of Science:

• Pediatric Traumatology
• Neurocritical Care
• Clinical Decision Support

Background:

• Pediatric brain injuries, specifically mild traumatic intracranial hemorrhage (T-ICH), are common.
• Current management of pediatric T-ICH is suboptimal, leading to overuse of repeat head CTs (RHCT) and neurosurgical consultations (NSC).
• Brain Injury Guidelines (BIG) offer a standardized framework for TBI management, with potential applicability to pediatric populations.

Purpose of the Study:

• To apply the Brain Injury Guidelines (BIG) to a low-risk pediatric TBI population.
• To evaluate the safety and efficacy of the BIG framework in reducing overutilization of RHCT and NSC in children.
• To determine if BIG can be safely applied to pediatric patients with mild T-ICH.

Main Methods:

• Retrospective chart review of a pediatric trauma registry over four years.
• Application of BIG criteria to identify patients eligible for evaluation of RHCT and neurosurgical intervention (NSG-I).
• Inclusion of patients with minor skull fractures (mSFx) who otherwise met BIG-1 criteria.

Main Results:

• Twenty-eight pediatric patients with low-risk T-ICH were reviewed.
• RHCT was performed in seven patients; only two were clinically indicated.
• No patient meeting BIG-1 criteria (with or without mSFx) required NSG-I.

Conclusions:

• The BIG criteria can be safely applied to children with mild T-ICH, reducing RHCT and NSC.
• Pediatric patients with mSFx meeting BIG-1 criteria can be managed by acute care surgeons.
• Further prospective studies are needed to validate these findings in larger pediatric populations.