Predicting and improving outcome in severe pediatric traumatic brain injury

Area of Science:

• Pediatric Neurology
• Neurotrauma
• Public Health

Background:

• Severe pediatric traumatic brain injury (spTBI), including abusive head trauma (AHT), presents substantial long-term physical, neurological, cognitive, behavioral, and social challenges.
• spTBI is a critical public health concern with significant lifelong consequences for affected children.

Purpose of the Study:

• To provide a comprehensive narrative review of spTBI, covering causes, epidemiology, critical care, outcomes, and interventions.
• To synthesize current research from 2019-2024, including seminal prior work, on spTBI management and long-term effects.

Main Methods:

• Narrative review of published studies and reviews on spTBI from January 2019 to February 2024.
• Inclusion of significant pre-2019 papers to provide historical context and foundational knowledge.

Main Results:

• Significant disparities exist in spTBI causes, treatments, and outcomes based on country and socioeconomic factors.
• Abusive head trauma (AHT) is associated with poor outcomes, and adherence to critical care guidelines requires improvement.
• Neuroimaging and biomarkers are evolving predictors of outcomes, with long-term cognitive and psychosocial difficulties being the most prevalent and disabling.

Conclusions:

• Distinguishing between objective and subjective measures is crucial for assessing long-term difficulties post-spTBI.
• Family/caregiver-centered interventions, ecological approaches, and technology-assisted delivery are recommended to mitigate long-term challenges.
• Further investigation into the evidence base for critical care guidelines is warranted.