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Severe Traumatic Brain Injury in French-Speaking Pediatric Intensive Care Units: Study of Practices
Manon Denis1,2,3,4, Benjamin Lauzier4, Nadia Roumeliotis5,6
1Pediatric Intensive Care Unit, CHU de Caen, Caen, France.
Insights
Pediatric traumatic brain injury (TBI) management shows varied adherence to 2019 guidelines. While some areas like seizure prophylaxis are consistent, others like oxygenation monitoring require improvement for better TBI care.
Area of Science:
- Pediatric intensive care
- Neurology
- Trauma management
Background:
- Management strategies for severe pediatric traumatic brain injury (TBI) lack established best practices, leading to significant variations in professional approaches.
- Updated guidelines aim to standardize care, but compliance and effectiveness require ongoing assessment.
Purpose of the Study:
- To evaluate the adherence of French-speaking pediatric intensive care physicians to the 2019 pediatric TBI management guidelines.
- To identify areas of strong compliance and persistent variations in TBI care practices.
Main Methods:
- A survey assessing 70 questions across 15 items of the 2019 TBI guidelines was distributed to physicians.
- The survey focused on the assessment and management of TBI during acute and intensive care phases.
- Data from 78 physicians were analyzed for guideline compliance.
Main Results:
- Physicians adhered to over 60% of the guidelines for 10 out of 15 items.
- Strong adherence was noted for seizure prophylaxis (levetiracetam) and CO2 thresholds.
- Inconsistent management was observed for sodium/glucose thresholds and transcranial Doppler use; brain tissue oxygenation and autoregulation monitoring were uncommon.
Conclusions:
- Stated practices for pediatric TBI management show relative standardization, particularly for intracranial and cerebral perfusion pressure thresholds.
- Variations persist in areas lacking robust evidence and pediatric-specific recommendations, highlighting a need for further research and guideline refinement.
Abstract:
Best strategies for managing severe pediatric traumatic brain injury (TBI) are not established, with wide variations among professional practices. The main objective of this study was to assess compliance with updated pediatric TBI management guidelines (2019). A survey was distributed among French-speaking pediatric intensive care physicians from April 1 to June 30, 2019. The survey was based on a clinical case with a total of 70 questions that cover the 15 items of the 2019 TBI guidelines. The questions evaluated the assessment and management of TBI during the acute and intensive care phases. Of 487 e-mails sent, 78 surveys were included. Guidelines were adhered to (> 60%) for 10 of 15 items in the guidelines. Strong adherence to recent guideline changes was achieved for seizure prophylaxis with levetiracetam ( n = 21/33, 64%) and partial pressure of carbon dioxide threshold ( n = 52, 67%). However, management of the sodium and glucose thresholds and the role of transcranial Doppler were not consistent with the guidelines. Assessment of brain tissue oxygenation ( n = 12, 16%) and autoregulation ( n = 35, 45%) was not a common practice. There was strong agreement among clinicians on the intracranial pressure (> 80%) and cerebral perfusion pressure (> 70%) thresholds used according to age. Overall, stated practices for the management of TBI appear to be relatively standardized among responders. Variations persist in areas with a lack of evidence and pediatric-specific recommendations.
