The pediatric Brain Injury Guidelines: a retrospective clinical validation study

Area of Science:

• Pediatric Traumatology
• Neurocritical Care
• Clinical Guidelines

Background:

• Pediatric traumatic brain injury (TBI) is a major cause of morbidity and healthcare resource utilization.
• Identifying patients with traumatic intracranial hemorrhage (ICH) who do not require intensive management is crucial.

Purpose of the Study:

• To validate the pediatric Brain Injury Guidelines (pBIG) in identifying pediatric ICH patients who can avoid repeat neuroimaging, neurosurgical consultation, or hospital admission.
• To assess the utility of pBIG in a large cohort of pediatric trauma patients.

Main Methods:

• Retrospective review of pediatric patients with traumatic ICH (2018-2022).
• Patients were categorized using pBIG clinical and radiographic criteria; nonaccidental trauma was excluded.
• Outcomes included repeat neuroimaging, neurosurgical intervention, length of stay, and 30-day mortality.

Main Results:

• 955 patients were analyzed; 9.7% had pBIG 1, 30.0% pBIG 2, and 60.2% pBIG 3 injuries.
• Neurosurgical intervention was required in 13.5% of patients, predominantly those meeting pBIG 3 criteria.
• Patients with pBIG 1 and pBIG 2 injuries had near-zero rates of neurosurgical intervention and mortality.

Conclusions:

• The pBIG are validated for stratifying a broad population of pediatric TBI patients with ICH.
• The guidelines can safely reduce unnecessary resource utilization without compromising patient outcomes.
• Specific pBIG 3 criteria like scattered subarachnoid hemorrhage (SAH) may not necessitate neurosurgical intervention.