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Below you will find a summary of the guideline “A guideline for brain injury in children enables the safe management of traumatic brain injuries by trauma surgeons”, published in the July 2024 issue of Pediatrics by McNickle et al.
Researchers have introduced a pediatric brain injury guideline (pBIG) to stratify traumatic brain injury (TBI) and treat less severe cases without the need for repeated CT imaging or neurosurgical consultations. TBIs were classified into mild (pBIG1), moderate (pBIG2), severe (pBIG3), or isolated skull fracture (ISF) based on neurologic status, size, and number of hemorrhages. The main hypothesis was that pediatric TBIs could be safely treated using this guideline.
The study group analyzed data from the Pediatric Trauma Registry for isolated TBIs in patients under 18 years of age from July 2021 to March 2023, after implementation of the pBIG. The dataset included patient age, injury details, repeat head CTs, neurosurgical consultations and interventions. Statistical analysis was performed using Stata, with significance at p
The study included 139 children with a mean age of 2.8 years. The most common injuries were skull fractures (113 cases, 81%) and subdural hematomas (54 cases, 39%). Repeat skull CTs were performed in 44 cases (32%) and neurosurgical consultation was performed in 89 cases (64%). Overall guideline adherence was 83.5%, with the highest compliance observed in the pBIG3 category (96%). One patient in the pBIG1 category had worsening symptoms requiring an upgrade to pBIG2, neurosurgical consultation, and repeat skull CT, although no surgical intervention was required. After discharge, five children (3.6%; four with isolated skull fractures and one with pBIG3) had to visit the emergency department, and one child (0.7%, ISF) underwent post-discharge CT. Three children (2.2%) in the pBIG3 category died from their injuries.
Compliance with the pBIG algorithm was 83.5%, with the lowest compliance observed in the moderate TBI category (pBIG2). This group had a higher rate of neurosurgical consultations, indicating potential inconvenience in self-management of moderate injuries compared to mild TBIs or isolated skull fractures. Overall, outcomes associated with the pBIG algorithm were considered acceptable, supporting its use to treat pediatric TBIs.
Source: sciencedirect.com/science/article/abs/pii/S0022346824004639
