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Updated: Dec 7, 2025

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Traumatic Brain Injury Practice Guidelines: Variability in U.K. PICUs.

Hari Krishnan Kanthimathinathan1,2, Hiren Mehta1, Barnaby R Scholefield1,3

  • 1Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham, United Kingdom.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|October 3, 2020
PubMed
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Pediatric traumatic brain injury (TBI) management guidelines in the UK show significant variability. While some areas like intracranial pressure treatment thresholds are consistent, others like monitoring indications vary widely, highlighting a need for standardization.

Area of Science:

  • Pediatric critical care medicine
  • Neurotrauma research
  • Evidence-based guideline analysis

Background:

  • Traumatic brain injury (TBI) in children is a major cause of death and disability.
  • Variability in pediatric intensive care unit (PICU) management of TBI may stem from a lack of high-quality evidence.
  • Standardizing TBI care is crucial for improving outcomes.

Purpose of the Study:

  • To examine the extent of variability in UK pediatric traumatic brain injury management guidelines.
  • To compare UK PICU guidelines against each other and the Brain Trauma Foundation guidelines.
  • To identify areas of consistency and variation in pediatric TBI management.

Main Methods:

  • Textual analysis of UK PICU guidelines for pediatric traumatic brain injury.

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  • Comparison of 15 guidelines from 16 UK PICUs against the Brain Trauma Foundation guidelines.
  • Evaluation of 12 key clinical topics across three TBI management domains.

    • Main Results:

    • Consistency observed in intracranial pressure treatment thresholds (10/15), avoiding prophylactic hyperventilation (15/15), cerebrospinal fluid drainage (13/15), barbiturate use (14/15), and decompressive craniectomy (12/15).
    • Significant variability found in indications for intracranial pressure monitoring (3/15), cerebral perfusion pressure targets (2/15), target osmolarities (7/15), and hyperventilation for intracranial hypertension (2/15).
    • Variability noted in the choice and hierarchy of interventions for intracranial hypertension.

    Conclusions:

    • Significant variability exists in pediatric traumatic brain injury management guidelines across UK PICUs.
    • Despite heterogeneity, some key areas of consistency in TBI management were identified.
    • Further work is needed to promote standardization in pediatric TBI care.