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Published on: March 26, 2019
Management of severe traumatic brain injury in pediatric patients: an evidence-based approach
Ana Paula de Carvalho Panzeri Carlotti1, Vivian Henriques do Amaral2, Ana Paula de Carvalho Canela Balzi2
1Division of Critical Care Medicine, Department of Pediatrics, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil. apcarlotti@fmrp.usp.br.
Insights
This study provides 14 evidence-based recommendations for managing severe traumatic brain injury (TBI) in children, aiming to standardize care and improve outcomes for pediatric TBI patients.
Area of Science:
- Pediatric Critical Care Medicine
- Neurotrauma Management
- Evidence-Based Medicine
Background:
- Severe traumatic brain injury (TBI) is a significant global cause of mortality and disability.
- Variability in healthcare management of TBI patients can lead to suboptimal outcomes.
- Minimizing secondary brain injury is crucial in severe TBI cases.
Purpose of the Study:
- To develop evidence-based recommendations for the management of severe TBI in children.
- To address variations in clinical practice for pediatric TBI.
- To provide guidance for healthcare practitioners caring for children with severe TBI.
Main Methods:
- A multidisciplinary panel conducted an 18-month comprehensive review of TBI management.
- Population, Intervention, Control, and Outcome (PICO) format was used to identify key questions.
- The Evidence to Decision (EtD) framework guided the evaluation of interventions.
Main Results:
- Fourteen evidence-based recommendations were formulated for severe TBI in children.
- Recommendations cover nine critical management topics, including imaging, neuromonitoring, and therapeutic interventions.
- Clinical recommendations and research priorities were identified for each topic.
Conclusions:
- This review synthesizes evidence to guide the care of children with severe TBI.
- The recommendations aim to standardize and improve the quality of care for pediatric TBI.
- Evidence-based strategies are provided to support clinical decision-making in pediatric neurotrauma.
Background:
Traumatic brain injury (TBI) is a major cause of death and disability worldwide. The decision-making process in the management of severe TBI must be based on the best available evidence to minimize the occurrence of secondary brain injuries. However, healthcare approaches to managing TBI patients exhibit considerable variation.
Methods:
Over an 18-month period, a multidisciplinary panel consisting of medical doctors, physiotherapists, nutritional therapists, and nurses performed a comprehensive review on various subtopics concerning TBI. The panel identified primary questions to be addressed using the Population, Intervention, Control, and Outcome (PICO) format and applied the Evidence to Decision (EtD) framework criteria for evaluating interventions. Subsequently, the panel formulated recommendations for the management of severe TBI in children.
Results:
Fourteen evidence-based recommendations have been devised for the management of severe TBI in children, covering nine topics, including imaging studies, neuromonitoring, prophylactic anticonvulsant use, hyperosmolar therapy, sedation and analgesia, mechanical ventilation strategies, nutritional therapy, blood transfusion, and decompressive craniectomy. For each topic, the panel provided clinical recommendations and identified research priorities.
Conclusions:
This review offers evidence-based strategies aimed to guide practitioners in the care of children who suffer from severe TBI.
