Computed Tomography Practice Standards for Severe Pediatric Traumatic Brain Injury in the Emergency Department: a...

Area of Science:

• Emergency Medicine
• Neurosurgery
• Pediatric Critical Care

Background:

• Managing severe traumatic brain injury (TBI) outside the resuscitation bay, particularly during computed tomography (CT) scans, presents significant challenges.
• Current clinical practices for pediatric severe TBI patients undergoing CT in the emergency department (ED) are not well-standardized across Canada.

Purpose of the Study:

• To investigate the current management practices of Canadian traumatologists for pediatric patients with severe TBI requiring CT scans in the ED.
• To identify variations in care and adverse events associated with CT imaging in this vulnerable population.

Main Methods:

• A national survey was distributed in 2019 to trauma directors at Canadian hospitals.
• The survey collected data on team composition, monitoring practices, equipment availability, and adverse events during CT scans for pediatric severe TBI patients.

Main Results:

• Physicians (89%), registered nurses (100%), and respiratory therapists (38%) were present during CT scans.
• The average transit time to and from the CT scanner was one hour.
• Over half of respondents (56%) reported adverse events in CT, with significant hypotension (44%) being most common. Resuscitation equipment access varied widely (11-56%).
• Monitoring was comprehensive for most vitals, but end-tidal CO2 monitoring was only used by 56%. Head of bed elevation practices were split between flat (44%) and elevated (56%).

Conclusions:

• Significant practice variability exists among Canadian traumatologists in managing pediatric severe TBI patients during CT scans.
• This variability may stem from a lack of evidence-based guidelines for neuroimaging in the ED.
• Further research and knowledge translation are essential to optimize patient care and reduce adverse events during this critical diagnostic process.