Related Experiment Video
Updated: Oct 19, 2025
Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
Published on: August 16, 2019
Pediatric traumatic brain injury prehospital guidelines: a systematic review and appraisal
Zhe Wang1, Dellvin Nguonly2, Rebecca Y Du3
1Department of Neurological Surgery, Stony Brook University Renaissance School of Medicine, Health Science Center T12, Room 080, 100 Nicolls Rd, Stony Brook, NY, 11790, USA. zhe.wang@stnoybrookmedicine.edu.
Insights
Clinical practice guidelines for pediatric traumatic brain injury (TBI) prehospital care are primarily from high-income countries. These guidelines can inform low- and middle-income countries
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Global Health
Background:
- Traumatic brain injury (TBI) significantly impacts children in low- and middle-income countries (LMICs).
- Effective prehospital emergency care is crucial for mitigating secondary brain injury and improving outcomes in pediatric TBI.
- Existing clinical practice guidelines (CPGs) for pediatric TBI prehospital management require evaluation for applicability in resource-limited settings.
Purpose of the Study:
- To systematically review existing clinical practice guidelines (CPGs) for the prehospital management of pediatric traumatic brain injury (TBI).
- To assess the quality of these CPGs using the Appraisal of Guidelines for Research & Evaluation (AGREE) tool.
- To provide recommendations for adapting and implementing high-quality CPGs in low- and middle-income countries (LMICs).
Main Methods:
- Systematic literature search conducted across PubMed/Medline, Embase, and Web of Science databases.
- Appraisal of evidence-based CPGs for pediatric TBI prehospital management using the AGREE tool.
- High-quality CPGs were defined as those scoring >60% in at least 5 out of 6 AGREE domains.
Main Results:
- Ten CPGs were included in the analysis, all originating from high-income countries (HICs).
- Four of the 10 CPGs were rated as high-quality based on AGREE tool criteria.
- A total of 154 recommendations were categorized into initial assessment (35.7%), prehospital treatment (38.3%), and triage (26.0%), with 51.3% being evidence-based and 20.1% consensus-based.
Conclusions:
- Current prehospital pediatric TBI CPGs are predominantly developed in HICs, highlighting a gap for LMICs.
- Four high-quality CPGs offer a foundation for developing context-specific guidelines in resource-limited settings.
- Adapting and implementing evidence-based recommendations is essential for LMICs to address the public health challenge of pediatric TBI.
Background:
Traumatic brain injury (TBI) disproportionately affects children within low- and middle-income countries (LMICs). Prehospital emergency care can mitigate secondary brain injury and improve outcomes. Here, we systematically review clinical practice guidelines (CPGs) for pediatric TBI with the goal to inform LMICs prehospital care.
Methods:
A systematic search was conducted in PubMed/Medline, Embase, and Web of Science databases. We appraised evidence-based CPGs addressing prehospital management of pediatric TBI using the Appraisal of Guidelines for Research & Evaluation (AGREE) tool. CPGs were rated as high-quality if ≥ 5 (out of 6) AGREE domains scored > 60%.
Results:
Of the 326 articles identified, 10 CPGs were included in analysis. All 10 were developed in HICs, and 4 were rated as high-quality. A total of 154 pediatric prehospital recommendations were grouped into three subcategories, initial assessment (35.7%), prehospital treatment (38.3%), and triage (26.0%). Of these, 79 (51.3%) were evidence-based with grading, and 31 (20.1%) were consensus-based without direct evidence.
Conclusion:
Currently available CPGs for prehospital pediatric TBI management were all developed in HICs. Four CPGs have high-quality, and recommendations from these can serve as frameworks for LMICs or resource-limited settings. Context-specific evaluation and implementation of evidence-based recommendations allow LMIC settings to respond to the public health crisis of pediatric TBI and address gaps in trauma care systems.
