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Clinical Practice Guideline Recommendations in Pediatric Mild Traumatic Brain Injury: A Systematic Review
Lynne Moore1, Anis Ben Abdeljelil1, Pier-Alexandre Tardif2
1Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Department of Social and Preventative Medicine, Université Laval, Québec, Québec, Canada.
Insights
This study identified 34 evidence-based recommendations for pediatric mild traumatic brain injury (mTBI) care in emergency departments. High-quality guidelines are crucial for effective implementation and improved patient outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Practice Guidelines
Background:
- Acute mild traumatic brain injury (mTBI) is common in children presenting to emergency departments (EDs).
- Clinical practice guidelines (CPGs) aim to standardize care for pediatric mTBI.
- Appraising the quality of existing CPGs is essential for evidence-based implementation.
Approach:
- Systematic review of CPGs for pediatric mTBI in EDs (January 2012-May 2023).
- Quality appraisal using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool.
- Evidence quality synthesized using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.
Key Points:
- Eleven CPGs were reviewed; 6 (55%) were high quality.
- 101 recommendations were identified, with 34 (34%) based on moderate- to high-quality evidence.
- No evidence-based recommendations found for repeat imaging, neurosurgical consultation, or hospital admission in high-quality CPGs.
- Methodological weaknesses included lack of implementation strategies and editorial independence.
Conclusions:
- 34 evidence-based recommendations for pediatric mTBI care are suitable for clinical implementation.
- Future research should address identified evidence gaps.
- Strategies to facilitate CPG implementation are vital for pediatric mTBI management.
Study Objective:
Our primary objectives were to identify clinical practice guideline recommendations for children with acute mild traumatic brain injury (mTBI) presenting to an emergency department (ED), appraise their overall quality, and synthesize the quality of evidence and the strength of included recommendations.
Methods:
We searched MEDLINE, EMBASE, Cochrane Central, Web of Science, and medical association websites from January 2012 to May 2023 for clinical practice guidelines with at least 1 recommendation targeting pediatric mTBI populations presenting to the ED within 48 hours of injury for any diagnostic or therapeutic intervention in the acute phase of care (ED and inhospital). Pairs of reviewers independently assessed overall clinical practice guideline quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. The quality of evidence on recommendations was synthesized using a matrix based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework.
Results:
We included 11 clinical practice guidelines, of which 6 (55%) were rated high quality. These included 101 recommendations, of which 34 (34%) were based on moderate- to high-quality evidence, covering initial assessment, initial diagnostic imaging, monitoring/observation, therapeutic interventions, discharge advice, follow-up, and patient and family support. We did not identify any evidence-based recommendations in high-quality clinical practice guidelines for repeat imaging, neurosurgical consultation, or hospital admission. Lack of strategies and tools to aid implementation and editorial independence were the most common methodological weaknesses.
Conclusions:
We identified 34 recommendations based on moderate- to high-quality evidence that may be considered for implementation in clinical settings. Our review highlights important areas for future research. This review also underlines the importance of providing strategies to facilitate the implementation of clinical practice guideline recommendations for pediatric mTBI.
