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The management of pediatric severe traumatic brain injury: Italian Guidelines
Leonardo Bussolin1, Martina Falconi2, Maria C Leo2
1Neuroanesthesiology, Intensive Care and Trauma Center, A. Meyer University Hospital, Florence, Italy.
Insights
This study updates severe traumatic brain injury guidelines for pediatric patients in Italy. It provides 25 evidence-based recommendations to improve care and reduce practice variations for severe pediatric head injuries.
Area of Science:
- Neuroscience
- Pediatric Medicine
- Trauma Surgery
Background:
- Severe traumatic brain injury (TBI) in children requires updated management strategies.
- Existing guidelines need revision to incorporate new evidence.
- Variations in clinical practice necessitate standardized Italian national guidelines.
Purpose of the Study:
- To update the 2012
Main Methods:
- Systematic literature search of MEDLINE and EMBASE (2009-2017).
- Inclusion of pediatric or mixed populations with age subgroup analyses.
- Multidisciplinary expert panel formulation of evidence-based recommendations.
Main Results:
- 67 articles were included after screening 4254 initially identified.
- The guideline update comprises 25 evidence-based and 5 research recommendations.
- Significant progress in understanding pediatric TBI, yet evidence quality remains limited.
Conclusions:
- The updated guideline aims to standardize the management of severe pediatric head injuries in Italy.
- Evidence-based recommendations are provided to optimize patient care.
- Further research is recommended due to the low quantity and quality of current evidence.
Introduction:
The aim of the work was to update the "Guidelines for the Management of Severe Traumatic Brain Injury" published in 2012, to reflect the new available evidence, and develop the Italian national guideline for the management of severe pediatric head injuries to reduce variation in practice and ensure optimal care to patients.
Evidence Acquisition:
MEDLINE and EMBASE were searched from January 2009 to October 2017. Inclusion criteria were English language, pediatric populations (0-18 years) or mixed populations (pediatric/adult) with available age subgroup analyses. The guideline development process was started by the Promoting Group that composed a multidisciplinary panel of experts, with the representatives of the Scientific Societies, the independent expert specialists and a representative of the Patient Associations. The panel selected the clinical questions, discussed the evidence and formulated the text of the recommendations. The documentarists of the University of Florence oversaw the bibliographic research strategy. A group of literature reviewers evaluated the selected literature and compiled the table of evidence for each clinical question.
Evidence Synthesis:
The search strategies identified 4254 articles. We selected 3227 abstract (first screening) and, finally included 67 articles (second screening) to update the guideline. This Italian update includes 25 evidence-based recommendations and 5 research recommendations.
Conclusions:
In recent years, progress has been made on the understanding of severe pediatric brain injury, as well as on that concerning all major traumatic pathology. This has led to a progressive improvement in the clinical outcome, although the quantity and quality of evidence remains particularly low.
