Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children
Franz E Babl1,2,3, Emma Tavender2,3, Dustin W Ballard4
1Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
This study developed a practical clinical guideline for managing mild to moderate head injuries in children across Australian and New Zealand emergency departments. The guideline offers evidence-based recommendations for triage, imaging, and discharge decisions.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Practice Guidelines
Background:
- Children frequently sustain head injuries requiring acute care.
- Existing international guidelines lack specific applicability to the Australian and New Zealand context for mild to moderate head injuries.
- Key considerations include triage, imaging, observation, admission, transfer, discharge, and follow-up.
Purpose of the Study:
- To develop an evidence-based, locally applicable clinical guideline for the care of children with mild to moderate head injuries in Australian and New Zealand acute care settings.
- To address gaps in existing international guidelines concerning pediatric head injury management.
- To provide practical guidance for front-line clinicians.
Main Methods:
- A multidisciplinary Guideline Working Group (GWG) formulated 33 clinical questions across triage, imaging, and discharge.
- Existing high-quality guidelines were identified, and recommendations were mapped.
- Literature searches were conducted, new evidence was identified, and recommendations were developed through adoption, adaptation, or de novo creation.
- The guideline underwent revision following public consultation.
Main Results:
- The Guideline Working Group generated 71 recommendations (35 evidence-informed, 17 consensus-based, 19 practice points) tailored for the Australian and New Zealand setting.
- The guideline is disseminated through three documents: a Full Guideline, a Guideline Summary, and a clinical Algorithm for Imaging and Observation Decision-making.
- The algorithm specifically aids in decision-making for imaging and observation in pediatric head injuries.
Conclusions:
- The PREDICT (Paediatric Research in Emergency Departments International Collaborative) guideline offers high-level evidence and practical advice for managing mild to moderate head injuries in children.
- It provides a crucial resource for Australian and New Zealand clinicians.
- The guideline aims to standardize and improve the care of pediatric head injuries.
Objective:
Children frequently present with head injuries to acute care settings. Although international paediatric clinical practice guidelines for head injuries exist, they do not address all considerations related to triage, imaging, observation versus admission, transfer, discharge and follow-up of mild to moderate head injuries relevant to the Australian and New Zealand context. The Paediatric Research in Emergency Departments International Collaborative (PREDICT) set out to develop an evidence-based, locally applicable, practical clinical guideline for the care of children with mild to moderate head injuries presenting to acute care settings.
Methods:
A multidisciplinary Guideline Working Group (GWG) developed 33 questions in three key areas - triage, imaging and discharge of children with mild to moderate head injuries presenting to acute care settings. We identified existing high-quality guidelines and from these guidelines recommendations were mapped to clinical questions. Updated literature searches were undertaken, and key new evidence identified. Recommendations were created through either adoption, adaptation or development of de novo recommendations. The guideline was revised after a period of public consultation.
Results:
The GWG developed 71 recommendations (evidence-informed = 35, consensus-based = 17, practice points = 19), relevant to the Australian and New Zealand setting. The guideline is presented as three documents: (i) a detailed Full Guideline summarising the evidence underlying each recommendation; (ii) a Guideline Summary; and (iii) a clinical Algorithm: Imaging and Observation Decision-making for Children with Head Injuries.
Conclusions:
The PREDICT Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children provides high-level evidence and practical guidance for front line clinicians.
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