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Pediatric head trauma is one of the most common reasons for consultation in the ED, and can be mild, moderate or severe. The most common causes of head trauma in children and youth presenting to Canadian EDs include falls, sports-related injuries, being hit on the head by an object or by colliding with an obstacle, or injuries involving bicycles and motor vehicles. Annual rates range from 130 to 200 cases per 100,000 population, leading to at least 20,000 emergency department visits in Canadian pediatric hospitals per year.

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Bottom Line Recommendations English (2) French (1) All (3)

Bottom Line Recommendations: Severe Head Injury

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Beno S and the TREKK Network

Updated bottom line recommendations for the treatment and management of severe head trauma. Published online: October 2017.

Bottom Line: Assessment in the emergency department for patients with head injury

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National Institute for Health and Care Excellence (NICE), National Clincial G...

A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive and designed to be used online.

Recommendations de Base: Traumatisme Cranien Severe

Download

Beno S and the TREKK Network

Updated bottom line recommendations for the treatment and management of severe head trauma - French. Version 2.1 published online: October 2018.

Bottom Line Recommendations: Severe Head Injury

Download

Beno S and the TREKK Network

Updated bottom line recommendations for the treatment and management of severe head trauma. Published online: October 2017.

Recommendations de Base: Traumatisme Cranien Severe

Download

Beno S and the TREKK Network

Updated bottom line recommendations for the treatment and management of severe head trauma - French. Version 2.1 published online: October 2018.

Bottom Line: Assessment in the emergency department for patients with head injury

Visit

National Institute for Health and Care Excellence (NICE), National Clincial G...

A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive and designed to be used online.

Clinical guidelines English (4) French All (4)

Clinical Practice Guideline: Head injury: assessment and early management

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National Institute for Health and Care Excellence (NICE), National Clincial G...

This guideline covers the assessment and early management of head injury in children, young people and adults. It promotes effective clinical assessment so that people receive the right care for the severity of their head injury, including referral directly to specialist care if needed.

Clinical Practice Guideline: Management of the paediatric patient with acute head trauma

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Farrell CA, Canadian Paediatric Society Acute Care Committee

The purpose of this statement is to describe issues related to head trauma in infants, children and youth, including clinical manifestations, initial management priorities, guidelines for imaging, and subsequent observation and treatment.

Clinical Practice Guideline: Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition

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Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, Carson S, Ch...

Published in 2012, these guidelines reflect updated information from the first edition published in 2003. Thisdocument is endorsed by the American Academy of Pediatrics-Section on Neurological Surgery, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Child Neurology Society, European Society of Pediatric and Neonatal Intensive Care, Neurocritical Care Society, Pediatric Neurocritical Care Research Group, Society of Critical Care Medicine, The Paediatric Intensive Care Society (UK), Society for Neuroscience in Anesthesiology and Critical Care, and the World Federation of Pediatric Intensive and Critical Care Societies.

Clinical Practice Guideline: Multidisciplinary guidelines on the identification, investigation and management of suspected abusive head trauma

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Canadian Paediatric Society

The Multidisciplinary Guidelines on the Identification, Investigation and Management of Suspected Abusive Head Trauma have been prepared in order to provide community organizations with assistance in developing local protocols for managing cases of Abusive Head Trauma. The guidelines are intended to be generic enough that large or small communities can use them to help develop a resoinse appropriate to their specific circumstances.

Clinical Practice Guideline: Head injury: assessment and early management

Visit

National Institute for Health and Care Excellence (NICE), National Clincial G...

This guideline covers the assessment and early management of head injury in children, young people and adults. It promotes effective clinical assessment so that people receive the right care for the severity of their head injury, including referral directly to specialist care if needed.

Clinical Practice Guideline: Management of the paediatric patient with acute head trauma

Visit

Farrell CA, Canadian Paediatric Society Acute Care Committee

The purpose of this statement is to describe issues related to head trauma in infants, children and youth, including clinical manifestations, initial management priorities, guidelines for imaging, and subsequent observation and treatment.

Clinical Practice Guideline: Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition

Visit

Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, Carson S, Ch...

Published in 2012, these guidelines reflect updated information from the first edition published in 2003. Thisdocument is endorsed by the American Academy of Pediatrics-Section on Neurological Surgery, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Child Neurology Society, European Society of Pediatric and Neonatal Intensive Care, Neurocritical Care Society, Pediatric Neurocritical Care Research Group, Society of Critical Care Medicine, The Paediatric Intensive Care Society (UK), Society for Neuroscience in Anesthesiology and Critical Care, and the World Federation of Pediatric Intensive and Critical Care Societies.

Clinical Practice Guideline: Multidisciplinary guidelines on the identification, investigation and management of suspected abusive head trauma

Visit

Canadian Paediatric Society

The Multidisciplinary Guidelines on the Identification, Investigation and Management of Suspected Abusive Head Trauma have been prepared in order to provide community organizations with assistance in developing local protocols for managing cases of Abusive Head Trauma. The guidelines are intended to be generic enough that large or small communities can use them to help develop a resoinse appropriate to their specific circumstances.

Summaries of systematic reviews English (4) French All (4)

Summary: Haemostatic drugs for traumatic brain injury

Visit

Perel P, Roberts I, Shakur H, Thinkhamrop B, Phuenpathom N, Yutthakasemsunt S

We searched for randomised clinical trials looking at theeffectivenessof haemostatic drugs for reducingmortalityand disability in patients with traumatic brain injury.

Summary: Corticosteroids to treat brain injury

Visit

Alderson P, Roberts I

Thereviewauthors searched the medical literature to determine how effective and safe corticosteroids are for treating brain injury.

Summary: Hypothermia (body temperature cooling) for traumatic head injury

Visit

Sydenham E, Roberts I, Alderson P

Thisreviewincludes twenty-three randomised controlled trials involving 1614 patients with traumatic head injury. In eachtrial, the patients were randomly divided into two groups: one group remained at normal body temperature, and the other group was cooled to a maximum of 35 degrees Celsius (or 95 degrees Fahrenheit) for at least 12 consecutive hours. Information on death, disability, and pneumonia were evaluated for each trial.

Summary: Wearing a helmet dramatically reduces the risk of head and facial injuries for bicyclists involved in a crash, even if it involves a motor vehicle

Visit

Thompson DC, Rivara FP, Thompson R

Thereviewfound that wearing a helmet reduced theriskof head or brain injury by approximately two-thirds or more, regardless of whether the crash involved a motor vehicle.

Summary: Haemostatic drugs for traumatic brain injury

Visit

Perel P, Roberts I, Shakur H, Thinkhamrop B, Phuenpathom N, Yutthakasemsunt S

We searched for randomised clinical trials looking at theeffectivenessof haemostatic drugs for reducingmortalityand disability in patients with traumatic brain injury.

Summary: Corticosteroids to treat brain injury

Visit

Alderson P, Roberts I

Thereviewauthors searched the medical literature to determine how effective and safe corticosteroids are for treating brain injury.

Summary: Hypothermia (body temperature cooling) for traumatic head injury

Visit

Sydenham E, Roberts I, Alderson P

Thisreviewincludes twenty-three randomised controlled trials involving 1614 patients with traumatic head injury. In eachtrial, the patients were randomly divided into two groups: one group remained at normal body temperature, and the other group was cooled to a maximum of 35 degrees Celsius (or 95 degrees Fahrenheit) for at least 12 consecutive hours. Information on death, disability, and pneumonia were evaluated for each trial.

Summary: Wearing a helmet dramatically reduces the risk of head and facial injuries for bicyclists involved in a crash, even if it involves a motor vehicle

Visit

Thompson DC, Rivara FP, Thompson R

Thereviewfound that wearing a helmet reduced theriskof head or brain injury by approximately two-thirds or more, regardless of whether the crash involved a motor vehicle.

Systematic reviews English (6) French All (6)

Systematic Review: Perioperative Care for Pediatric Patients With Penetrating Brain Injury: A Review

Visit

Mikhael M, Frost E, Cristancho M

We present an overview of PBI, its presenting features, epidemiology, and causes as well as an analysis of case series and the conclusions that may be drawn from those and other studies.

Systematic Review: The ketamine effect on ICP in traumatic brain injury

Visit

Zeiler FA, Teitelbaum J, West M, Gillman LM

Our goal was to perform a systematic review of the literature on the use of ketamine in traumatic brain injury (TBI) and its effects on intracranial pressure (ICP).

Systematic Review: Haemostatic drugs for traumatic brain injury

Visit

Perel P, Roberts I, Shakur H, Thinkhamrop B, Phuenpathom N, Yutthakasemsunt S

To assess the effects of haemostatic drugs on mortality, disability and thrombotic complications inpatientswith traumatic brain injury.

Systematic Review: Hypothermia for traumatic head injury

Visit

Sydenham E, Roberts I, Alderson P

To estimate the effect of mild hypothermia for traumaticheadinjury on mortality and long-term functional outcome complications.

Systematic Review: Corticosteroids for acute traumatic brain injury

Visit

Alderson P, Roberts I

To quantify the effectiveness and safety of corticosteroids in the treatment ofacutetraumatic brain injury.

Systematic Review: Helmets for preventing head and facial injuries in bicyclists

Visit

Thompson DC, Rivara FP, Thompson R

To determine whether bicycle helmets reducehead, brain and facial injury for bicyclists of all ages involved in a bicycle crash or fall.

Systematic Review: Perioperative Care for Pediatric Patients With Penetrating Brain Injury: A Review

Visit

Mikhael M, Frost E, Cristancho M

We present an overview of PBI, its presenting features, epidemiology, and causes as well as an analysis of case series and the conclusions that may be drawn from those and other studies.

Systematic Review: The ketamine effect on ICP in traumatic brain injury

Visit

Zeiler FA, Teitelbaum J, West M, Gillman LM

Our goal was to perform a systematic review of the literature on the use of ketamine in traumatic brain injury (TBI) and its effects on intracranial pressure (ICP).

Systematic Review: Haemostatic drugs for traumatic brain injury

Visit

Perel P, Roberts I, Shakur H, Thinkhamrop B, Phuenpathom N, Yutthakasemsunt S

To assess the effects of haemostatic drugs on mortality, disability and thrombotic complications inpatientswith traumatic brain injury.

Systematic Review: Hypothermia for traumatic head injury

Visit

Sydenham E, Roberts I, Alderson P

To estimate the effect of mild hypothermia for traumaticheadinjury on mortality and long-term functional outcome complications.

Systematic Review: Corticosteroids for acute traumatic brain injury

Visit

Alderson P, Roberts I

To quantify the effectiveness and safety of corticosteroids in the treatment ofacutetraumatic brain injury.

Systematic Review: Helmets for preventing head and facial injuries in bicyclists

Visit

Thompson DC, Rivara FP, Thompson R

To determine whether bicycle helmets reducehead, brain and facial injury for bicyclists of all ages involved in a bicycle crash or fall.

Key studies English (21) French All (21)

Key Study: Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department

Visit

Osmond MH, Klassen TP, Wells GA, Davidson J, Correll R, Boutis K, Joubert G, ...

Methods: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Physicians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule.

Key Study: Examining Emergency Department Treatment Processes in Severe Pediatric Traumatic Brain Injury

Visit

Ajdari A, Boyle LN, Kannan N, Rowhani-Rahbar A, Wang J, Mink R, Ries B, Wainw...

Our objectives were to examine the treatment process of acute pediatric TBI and the impact of non-value-added time (NVAT) on patient outcomes.

Key Study: Big for Small; Validating Brain Injury Guidelines in Pediatric Traumatic Brain Injury

Visit

Azim A, Jehan FS, Rhee P, O'Keeffe T, Tang A, Vercruysse G, Kulvatunyou N, La...

The aim of this study was to evaluate the established BIG (BIG-1 category) for managing pediatric traumatic brain injury (TBI) patients with intracranial hemorrhage (ICH) without NC (no-NC).

Key Study: Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department

Visit

Jennings RM, Burtner JJ, Pellicer JF, Nair DK, Bradford MC, Shaffer M, Uspal ...

Clinical decision rules have reduced use of computed tomography (CT) to evaluate minor pediatric head injury in pediatric emergency departments (EDs). CT use remains high in community EDs, where the majority of children seek medical care. We sought to reduce the rate of CT scans used to evaluate pediatric head injury from 29% to 20% in a community ED.

Key Study: Prevalence and Impact of Admission Acute Traumatic Coagulopathy on Treatment Intensity, Resource Use, and Mortality: An Evaluation of 956 Severely Injured Children and Adolescents

Visit

Liras IN, Caplan HW, Stensballe J, Wade CE, Cox CS, Cotton BA

The purpose of this study was to assess the prevalence and impact of arrival coagulopathy, determined by viscoelastic hemostatic testing, in severely injured children.

Key Study: Tripartite Stratification of the Glasgow Coma Scale in Children with Severe Traumatic Brain Injury and Mortality: An Analysis from a Multi-Center Comparative Effectiveness Study

Visit

Murphy S, Thomas NJ, Gertz SJ, Beca J, Luther JF, Bell MJ, Wisniewski SR, Har...

This study describes the distribution of GCS scores in the population, the relationship between injury characteristics with the GCS score, and the association between the tripartite stratification of the GCS on mortality in children with severe traumatic brain injury (TBI).

Key Study: Investigating the Connection Between Traumatic Brain Injury and Posttraumatic Stress Symptoms in Adolescents

Visit

Rhine T, Cassedy A, Yeates KO, Taylor HG, Kirkwood MW, Wade SL

To identify potentially modifiable individual and social-environmental correlates of posttraumatic stress symptoms (PTSS) among adolescents hospitalized for traumatic brain injury (TBI).

Key Study: Development and implementation of a standardized pathway in the Pediatric Intensive Care Unit for children with severe traumatic brain injuries

Visit

Rakes L, King M, Johnston B, Chesnut R, Grant R, Vavilala M

The aim of this quality improvement project was to increase TBI guideline adherence by implementing a standard care pathway for PICU management of children with severe TBI.

Key Study: Are CT scans obtained at referring institutions justified prior to transfer to a pediatric trauma center?

Visit

Benedict LA, Paulus JK, Rideout L, Chwals WJ

To assess whether pediatrictraumapatientsinitially evaluated at referring institutions met Massachusetts statewidetraumafield triage criteria for stabilization and immediate transfer to a PediatricTraumaCenter (PTC) without pre-transfer CT imaging.

Key Study: Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury

Visit

Vavilala MS, Kernic MA, Wang J, Kannan N, Mink RB, Wainwright MS, Groner JI, ...

The effect of the 2003 severe pediatric traumatic brain injury (TBI) guidelines on outcomes has not been examined. We aimed to develop a set ofacutecare guideline-influenced clinical indicators of adherence and tested the relationship between these indicators during the first 72 hours after hospital admission and discharge outcomes.

Key Study: Comparison of hypothermia and normothermia after severe traumatic brain injury in children (Cool Kids): a phase 3, randomised controlled trial

Visit

Adelson PD, Wisniewski SR, Beca J, Brown SD, Bell M, Muizelaar JP, Okada P, B...

On the basis of mixed results from previous trials, we assessed whether therapeutic hypothermia for 48-72 h with slow rewarming improved mortality in children after brain injury.

Key Study: Differences in medical therapy goals for children with severe traumatic brain injury-an international study

Visit

Bell MJ, Adelson PD, Hutchison JS, Kochanek PM, Tasker RC, Vavilala MS, Beers...

To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury.

Key Study: The emerging use of ketamine for anesthesia and sedation in traumatic brain injuries

Visit

Chang LC, Raty SR, Ortiz J, Bailard NS, Mathew SJ

This article reviews the current literature in regards to using ketamine inpatientswith traumatic brain injuries in different clinical settings associated with anesthesia, as well as reviews the potential mechanisms underlying the neuroprotective effects of ketamine.

Key Study: Early coagulopathy is an independent predictor of mortality in children after severe trauma

Visit

Whittaker B, Christiaans SC, Altice JL, Chen MK, Bartolucci AA, Morgan CJ, Ke...

To determine whether early coagulopathy affects the mortality associated with severe civilian pediatrictrauma,traumapatientsyounger than 18 years admitted to a pediatric intensive care unit from 2001 to 2010 were evaluated.

Key Study: Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study

Visit

Parri N, Crosby BJ, Glass C, Mannelli F, Sforzi I, Schiavone R, Ban KM

Our objective was to determine if bedside ED ultrasound is an accurate diagnostic tool for identifying skull fractures when compared toheadCT.

Key Study: CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury

Visit

Osmond MH, Klassen TP, Wells GA, Correll R, Jarvis A, Joubert G, Bailey B, Ch...

There is controversy about which children with minorheadinjury need to undergo computed tomography (CT). We aimed to develop a highly sensitive clinical decision rule for the use of CT in children with minorheadinjury.

Key Study: Early resuscitation of children with moderate-to-severe traumatic brain injury

Visit

Zebrack M, Dandoy C, Hansen K, Scaife E, Mann NC, Bratton SL

The purpose of this study was to identify the prevalence, monitoring, and treatment of hypotension and hypoxia during "early" (prehospital and emergency department) care and to evaluate their relationship to vital status and neurologic outcomes at hospital discharge.

Key Study: Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study

Visit

Kuppermann N, Holmes JF, Dayan PS, Hoyle JD, Atabaki SM, Holubkov R, Nadel FM...

CT imaging ofhead-injured children has risks of radiation-induced malignancy. Our aim was to identify children at very low risk of clinically-important traumatic brain injuries (ciTBI) for whom CT might be unnecessary.

Key Study: Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intracranial pressure

Visit

Jagannathan J, Okonkwo DO, Yeoh HK, Dumont AS, Saulle D, Haizlip J, Barth JT,...

Themanagementstrategies and outcomes in pediatricpatientswith elevated intracranial pressure (ICP) following severe traumatic brain injury (TBI) are examined in this study.

Key Study: Reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale: a measure of the use of intracranial pressure-directed therapies

Visit

Shore PM, Hand LL, Roy L, Trivedi P, Kochanek PM, Adelson PD

To test the reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale, a novel measure of overall therapeutic effort directed at controlling intracranial pressure (ICP) in the setting of severe (Glasgow Coma Scale of

Key Study: Clinical significance of scalp abnormalities in asymptomatic head-injured infants

Visit

Greenes DS, Schutzman SA

Objectives: 1) To identify clinical features indicating a high risk of skull fracture (SF) and associated intracranial injury (ICI) in asymptomatichead-injured infants. 2) To develop a clinical decision rule to determine which asymptomatichead-injured infants requireheadimaging.

Key Study: Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department

Visit

Osmond MH, Klassen TP, Wells GA, Davidson J, Correll R, Boutis K, Joubert G, ...

Methods: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Physicians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule.

Key Study: Examining Emergency Department Treatment Processes in Severe Pediatric Traumatic Brain Injury

Visit

Ajdari A, Boyle LN, Kannan N, Rowhani-Rahbar A, Wang J, Mink R, Ries B, Wainw...

Our objectives were to examine the treatment process of acute pediatric TBI and the impact of non-value-added time (NVAT) on patient outcomes.

Key Study: Big for Small; Validating Brain Injury Guidelines in Pediatric Traumatic Brain Injury

Visit

Azim A, Jehan FS, Rhee P, O'Keeffe T, Tang A, Vercruysse G, Kulvatunyou N, La...

The aim of this study was to evaluate the established BIG (BIG-1 category) for managing pediatric traumatic brain injury (TBI) patients with intracranial hemorrhage (ICH) without NC (no-NC).

Key Study: Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department

Visit

Jennings RM, Burtner JJ, Pellicer JF, Nair DK, Bradford MC, Shaffer M, Uspal ...

Clinical decision rules have reduced use of computed tomography (CT) to evaluate minor pediatric head injury in pediatric emergency departments (EDs). CT use remains high in community EDs, where the majority of children seek medical care. We sought to reduce the rate of CT scans used to evaluate pediatric head injury from 29% to 20% in a community ED.

Key Study: Prevalence and Impact of Admission Acute Traumatic Coagulopathy on Treatment Intensity, Resource Use, and Mortality: An Evaluation of 956 Severely Injured Children and Adolescents

Visit

Liras IN, Caplan HW, Stensballe J, Wade CE, Cox CS, Cotton BA

The purpose of this study was to assess the prevalence and impact of arrival coagulopathy, determined by viscoelastic hemostatic testing, in severely injured children.

Key Study: Tripartite Stratification of the Glasgow Coma Scale in Children with Severe Traumatic Brain Injury and Mortality: An Analysis from a Multi-Center Comparative Effectiveness Study

Visit

Murphy S, Thomas NJ, Gertz SJ, Beca J, Luther JF, Bell MJ, Wisniewski SR, Har...

This study describes the distribution of GCS scores in the population, the relationship between injury characteristics with the GCS score, and the association between the tripartite stratification of the GCS on mortality in children with severe traumatic brain injury (TBI).

Key Study: Investigating the Connection Between Traumatic Brain Injury and Posttraumatic Stress Symptoms in Adolescents

Visit

Rhine T, Cassedy A, Yeates KO, Taylor HG, Kirkwood MW, Wade SL

To identify potentially modifiable individual and social-environmental correlates of posttraumatic stress symptoms (PTSS) among adolescents hospitalized for traumatic brain injury (TBI).

Key Study: Development and implementation of a standardized pathway in the Pediatric Intensive Care Unit for children with severe traumatic brain injuries

Visit

Rakes L, King M, Johnston B, Chesnut R, Grant R, Vavilala M

The aim of this quality improvement project was to increase TBI guideline adherence by implementing a standard care pathway for PICU management of children with severe TBI.

Key Study: Are CT scans obtained at referring institutions justified prior to transfer to a pediatric trauma center?

Visit

Benedict LA, Paulus JK, Rideout L, Chwals WJ

To assess whether pediatrictraumapatientsinitially evaluated at referring institutions met Massachusetts statewidetraumafield triage criteria for stabilization and immediate transfer to a PediatricTraumaCenter (PTC) without pre-transfer CT imaging.

Key Study: Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury

Visit

Vavilala MS, Kernic MA, Wang J, Kannan N, Mink RB, Wainwright MS, Groner JI, ...

The effect of the 2003 severe pediatric traumatic brain injury (TBI) guidelines on outcomes has not been examined. We aimed to develop a set ofacutecare guideline-influenced clinical indicators of adherence and tested the relationship between these indicators during the first 72 hours after hospital admission and discharge outcomes.

Key Study: Comparison of hypothermia and normothermia after severe traumatic brain injury in children (Cool Kids): a phase 3, randomised controlled trial

Visit

Adelson PD, Wisniewski SR, Beca J, Brown SD, Bell M, Muizelaar JP, Okada P, B...

On the basis of mixed results from previous trials, we assessed whether therapeutic hypothermia for 48-72 h with slow rewarming improved mortality in children after brain injury.

Key Study: Differences in medical therapy goals for children with severe traumatic brain injury-an international study

Visit

Bell MJ, Adelson PD, Hutchison JS, Kochanek PM, Tasker RC, Vavilala MS, Beers...

To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury.

Key Study: The emerging use of ketamine for anesthesia and sedation in traumatic brain injuries

Visit

Chang LC, Raty SR, Ortiz J, Bailard NS, Mathew SJ

This article reviews the current literature in regards to using ketamine inpatientswith traumatic brain injuries in different clinical settings associated with anesthesia, as well as reviews the potential mechanisms underlying the neuroprotective effects of ketamine.

Key Study: Early coagulopathy is an independent predictor of mortality in children after severe trauma

Visit

Whittaker B, Christiaans SC, Altice JL, Chen MK, Bartolucci AA, Morgan CJ, Ke...

To determine whether early coagulopathy affects the mortality associated with severe civilian pediatrictrauma,traumapatientsyounger than 18 years admitted to a pediatric intensive care unit from 2001 to 2010 were evaluated.

Key Study: Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study

Visit

Parri N, Crosby BJ, Glass C, Mannelli F, Sforzi I, Schiavone R, Ban KM

Our objective was to determine if bedside ED ultrasound is an accurate diagnostic tool for identifying skull fractures when compared toheadCT.

Key Study: CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury

Visit

Osmond MH, Klassen TP, Wells GA, Correll R, Jarvis A, Joubert G, Bailey B, Ch...

There is controversy about which children with minorheadinjury need to undergo computed tomography (CT). We aimed to develop a highly sensitive clinical decision rule for the use of CT in children with minorheadinjury.

Key Study: Early resuscitation of children with moderate-to-severe traumatic brain injury

Visit

Zebrack M, Dandoy C, Hansen K, Scaife E, Mann NC, Bratton SL

The purpose of this study was to identify the prevalence, monitoring, and treatment of hypotension and hypoxia during "early" (prehospital and emergency department) care and to evaluate their relationship to vital status and neurologic outcomes at hospital discharge.

Key Study: Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study

Visit

Kuppermann N, Holmes JF, Dayan PS, Hoyle JD, Atabaki SM, Holubkov R, Nadel FM...

CT imaging ofhead-injured children has risks of radiation-induced malignancy. Our aim was to identify children at very low risk of clinically-important traumatic brain injuries (ciTBI) for whom CT might be unnecessary.

Key Study: Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intracranial pressure

Visit

Jagannathan J, Okonkwo DO, Yeoh HK, Dumont AS, Saulle D, Haizlip J, Barth JT,...

Themanagementstrategies and outcomes in pediatricpatientswith elevated intracranial pressure (ICP) following severe traumatic brain injury (TBI) are examined in this study.

Key Study: Reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale: a measure of the use of intracranial pressure-directed therapies

Visit

Shore PM, Hand LL, Roy L, Trivedi P, Kochanek PM, Adelson PD

To test the reliability and validity of the Pediatric Intensity Level of Therapy (PILOT) scale, a novel measure of overall therapeutic effort directed at controlling intracranial pressure (ICP) in the setting of severe (Glasgow Coma Scale of

Key Study: Clinical significance of scalp abnormalities in asymptomatic head-injured infants

Visit

Greenes DS, Schutzman SA

Objectives: 1) To identify clinical features indicating a high risk of skull fracture (SF) and associated intracranial injury (ICI) in asymptomatichead-injured infants. 2) To develop a clinical decision rule to determine which asymptomatichead-injured infants requireheadimaging.