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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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Key Resources English (3) French (1) All (4)

UNDER REVIEW: 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.

Recommendations de Base: Traumatisme Crnien Svre

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Beno S & TREKK Network

Bottom line recommendations for the treatment and management of severe head trauma - French. Published online: September 2015.

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.

UNDER REVIEW: 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.

Recommendations de Base: Traumatisme Crnien Svre

Visit

Beno S & TREKK Network

Bottom line recommendations for the treatment and management of severe head trauma - French. Published online: September 2015.

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 (8) French All (8)

Clinical Practice Guideline: The management of pediatric severe traumatic brain injury: Italian Guidelines.

Visit

Bussolin L, Falconi M, Leo MC, Parri N, DE Masi S, Rosati A, et al

The aim of the work was to update the "Guidelines for the Management of Severe Traumatic Brain Injury" published in 2012, to reflect the new available evidence, and develop the Italian national guideline for the management of severe pediatric head injuries to reduce variation in practice and ensure optimal care to patients.

Clinical Practice Guideline: Australian and New Zealand guideline for mild to moderate head injuries in children

Visit

Babl FE, Tavender E, Dalziel S. On behalf of the Guideline Working Group for ...

Children frequently present with head injuries to acute care settings. Led by PREDICT (Paediatric Research in Emergency Departments International Collaborative), a multidisciplinary working group developed the first Australian and New Zealand guideline for mild to moderate head injuries in children. Addressing 33 key clinical questions, it contains 71 recommendations, and an imaging/observation algorithm. The Guideline provides evidence-based, locally applicable, practical clinical guidance for the care of children with mild to moderate head injuries presenting to acute care settings.

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 Pediatric Severe Traumatic Brain Injury: 2019 Consensus and Guidelines-Based Algorithm for First and Second Tier Therapies.

Visit

ochanek PM, Tasker RC, Bell MJ, Adelson PD, Carney N, Vavilala MS, et al

To produce a treatment algorithm for the ICU management of infants, children, and adolescents with severe traumatic brain injury.

Clinical Practice Guideline: Italian guidelines on the assessment and management of pediatric head injury in the emergency department.

Visit

Da Dalt L, Parri N, Amigoni A, Nocerino A, Selmin F, Manara R, et al.

We aim to formulate evidence-based recommendations to assist physicians decision-making in the assessment and management of children younger than 16 years presenting to the emergency department (ED) following a blunt head trauma with no suspicion of non-accidental injury.

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: Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children.

Visit

Lumba-Brown A, Yeates KO, Sarmiento K, Breiding MJ, Haegerich TM, Gioia GA, e...

Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States.

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.

Clinical Practice Guideline: The management of pediatric severe traumatic brain injury: Italian Guidelines.

Visit

Bussolin L, Falconi M, Leo MC, Parri N, DE Masi S, Rosati A, et al

The aim of the work was to update the "Guidelines for the Management of Severe Traumatic Brain Injury" published in 2012, to reflect the new available evidence, and develop the Italian national guideline for the management of severe pediatric head injuries to reduce variation in practice and ensure optimal care to patients.

Clinical Practice Guideline: Australian and New Zealand guideline for mild to moderate head injuries in children

Visit

Babl FE, Tavender E, Dalziel S. On behalf of the Guideline Working Group for ...

Children frequently present with head injuries to acute care settings. Led by PREDICT (Paediatric Research in Emergency Departments International Collaborative), a multidisciplinary working group developed the first Australian and New Zealand guideline for mild to moderate head injuries in children. Addressing 33 key clinical questions, it contains 71 recommendations, and an imaging/observation algorithm. The Guideline provides evidence-based, locally applicable, practical clinical guidance for the care of children with mild to moderate head injuries presenting to acute care settings.

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 Pediatric Severe Traumatic Brain Injury: 2019 Consensus and Guidelines-Based Algorithm for First and Second Tier Therapies.

Visit

ochanek PM, Tasker RC, Bell MJ, Adelson PD, Carney N, Vavilala MS, et al

To produce a treatment algorithm for the ICU management of infants, children, and adolescents with severe traumatic brain injury.

Clinical Practice Guideline: Italian guidelines on the assessment and management of pediatric head injury in the emergency department.

Visit

Da Dalt L, Parri N, Amigoni A, Nocerino A, Selmin F, Manara R, et al.

We aim to formulate evidence-based recommendations to assist physicians decision-making in the assessment and management of children younger than 16 years presenting to the emergency department (ED) following a blunt head trauma with no suspicion of non-accidental injury.

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: Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children.

Visit

Lumba-Brown A, Yeates KO, Sarmiento K, Breiding MJ, Haegerich TM, Gioia GA, e...

Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States.

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.

Systematic reviews English (13) French All (13)

Cochrane Systematic Review: Interventions to reduce body temperature to 35 C to 37 C in adults and children with traumatic brain injury

Visit

Lewis SR, Baker PE, Andrews PJD, Cheng A, Deol K, Hammond N, Saxena M

To assess the effects of pharmacological interventions or physical interventions given with the intention of reducing body temperature to 35 C to 37.5 C in adults and children admitted to hospital after TBI.

Review: Addressing Key Clinical Care and Clinical Research Needs in Severe Pediatric Traumatic Brain Injury: Perspectives From a Focused International Conference.

Visit

Nacoti M, Fazzi F, Biroli F, Zangari R, Barbui T, Kochanek PM, Collaborative ...

We explore the clinical and research unmet needs focusing on severe pediatric TBI to identify best practices in pathways of care and optimize both inpatient and outpatient management of children following TBI.

Review: Monitoring and measurement of intracranial pressure in pediatric head trauma.

Visit

Pedersen SH, Lilja-Cyron A, Astrand R, Juhler M.

Monitoring of intracranial pressure (ICP) is an important and integrated part of the treatment algorithm for children with severe traumatic brain injury (TBI). Guidelines often recommend ICP monitoring with a treatment threshold of 20 mmHg. This focused review discusses; (1) different ICP technologies and how ICP should be monitored in pediatric patients with severe TBI, (2) existing evidence behind guideline recommendations, and (3) how we could move forward to increase knowledge about normal ICP in children to support treatment decisions.

Review: Emergency Department Implementation of the Brain Trauma Foundation's Pediatric Severe Brain Injury Guideline Recommendations.

Visit

Lumba-Brown A, Totten A, Kochanek PM.

Provides new and updated recommendations applicable to the emergency department management of children with severe traumatic brain injury. Practice-changing takeaways include specific recommendations for administration of 3% hypertonic saline, administration of seizure prophylaxis, and avoiding hyperventilation.

Review: Pediatric Head Trauma: A Review and Update.

Visit

Gelineau-Morel RN, Zinkus TP, Le Pichon JB.

There is still a considerable amount of confusion when it comes to managing concussions. An excessive number of head computed tomographic scans are being obtained for concussions, resulting in unnecessary exposure to ionizing radiation. Clinicians should be aware of the most recent guidelines for the management of concussion, including the need for imaging, and should be able to differentiate mild from moderate and severe traumatic brain injury.

Systematic Review: A systematic review and quality analysis of pediatric traumatic brain injury clinical practice guidelines.

Visit

Appenteng R, Nelp T, Abdelgadir J, Weledji N, Haglund M, Smith E, et al

To inform the creation of a pediatric TBI management guideline for a low and middle income country context, we assessed the quality of available clinical practice guidelines (CPGs) for the acute management pediatric TBI.

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.

Review: Approach to Pediatric Traumatic Brain Injury in the Emergency Department.

Visit

Belisle S, Lim R, Hochstadter E, Sangha G.

We discuss the initial management of traumatic brain injury based on mild, moderate and severe presentations. Management strategies to address Intracranial Pressure and Cerebral perfusion pressure, the use of oxygenation and ventilation strategies, temperature, correction of metabolic abnormalities and seizure care are discussed.

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: 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: 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.

Cochrane Systematic Review: Interventions to reduce body temperature to 35 C to 37 C in adults and children with traumatic brain injury

Visit

Lewis SR, Baker PE, Andrews PJD, Cheng A, Deol K, Hammond N, Saxena M

To assess the effects of pharmacological interventions or physical interventions given with the intention of reducing body temperature to 35 C to 37.5 C in adults and children admitted to hospital after TBI.

Review: Addressing Key Clinical Care and Clinical Research Needs in Severe Pediatric Traumatic Brain Injury: Perspectives From a Focused International Conference.

Visit

Nacoti M, Fazzi F, Biroli F, Zangari R, Barbui T, Kochanek PM, Collaborative ...

We explore the clinical and research unmet needs focusing on severe pediatric TBI to identify best practices in pathways of care and optimize both inpatient and outpatient management of children following TBI.

Review: Monitoring and measurement of intracranial pressure in pediatric head trauma.

Visit

Pedersen SH, Lilja-Cyron A, Astrand R, Juhler M.

Monitoring of intracranial pressure (ICP) is an important and integrated part of the treatment algorithm for children with severe traumatic brain injury (TBI). Guidelines often recommend ICP monitoring with a treatment threshold of 20 mmHg. This focused review discusses; (1) different ICP technologies and how ICP should be monitored in pediatric patients with severe TBI, (2) existing evidence behind guideline recommendations, and (3) how we could move forward to increase knowledge about normal ICP in children to support treatment decisions.

Review: Emergency Department Implementation of the Brain Trauma Foundation's Pediatric Severe Brain Injury Guideline Recommendations.

Visit

Lumba-Brown A, Totten A, Kochanek PM.

Provides new and updated recommendations applicable to the emergency department management of children with severe traumatic brain injury. Practice-changing takeaways include specific recommendations for administration of 3% hypertonic saline, administration of seizure prophylaxis, and avoiding hyperventilation.

Review: Pediatric Head Trauma: A Review and Update.

Visit

Gelineau-Morel RN, Zinkus TP, Le Pichon JB.

There is still a considerable amount of confusion when it comes to managing concussions. An excessive number of head computed tomographic scans are being obtained for concussions, resulting in unnecessary exposure to ionizing radiation. Clinicians should be aware of the most recent guidelines for the management of concussion, including the need for imaging, and should be able to differentiate mild from moderate and severe traumatic brain injury.

Systematic Review: A systematic review and quality analysis of pediatric traumatic brain injury clinical practice guidelines.

Visit

Appenteng R, Nelp T, Abdelgadir J, Weledji N, Haglund M, Smith E, et al

To inform the creation of a pediatric TBI management guideline for a low and middle income country context, we assessed the quality of available clinical practice guidelines (CPGs) for the acute management pediatric TBI.

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.

Review: Approach to Pediatric Traumatic Brain Injury in the Emergency Department.

Visit

Belisle S, Lim R, Hochstadter E, Sangha G.

We discuss the initial management of traumatic brain injury based on mild, moderate and severe presentations. Management strategies to address Intracranial Pressure and Cerebral perfusion pressure, the use of oxygenation and ventilation strategies, temperature, correction of metabolic abnormalities and seizure care are discussed.

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: 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: 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 (27) French All (27)

Key Study: Assessment of non-routine events and significant physiological disturbances during emergency department evaluation after pediatric head trauma.

Visit

Alberto EC, Harvey AR, Amberson MJ, Zheng Y, Thenappan AA, Oluigbo C, et al

The purpose of this study was to determine the association of non-routine events (NREs) during the initial resuscitation phase with these physiological disturbances.

Key Study: Intracranial pressure monitoring associated with increased mortality in pediatric brain injuries.

Visit

Delaplain PT, Grigorian A, Lekawa M, Mallicote M, Joe V, Schubl SD, et al.

Utilization of ICP monitors for pediatric patients is low and varies between centers. We hypothesized that in more severely injured patients (GCS 3-4), there would be a decreased mortality associated with invasive monitoring devices.

Key Study: Computed tomography practice standards for severe pediatric traumatic brain injury in the emergency department: a national survey.

Visit

Yoo G, Leach A, Woods R, Holt T, Hansen G.

Acute medical management of traumatic brain injury (TBI) can be challenging outside of the resuscitation bay, specifically while obtaining a computed tomography (CT) scan of the brain. We sought out to determine the management practices of Canadian traumatologists for pediatric patients with severe TBI requiring CT in the emergency department.

Key Study: The use of Rotterdam CT score for prediction of outcomes in pediatric traumatic brain injury patients admitted to emergency service.

Visit

Katar S, Aydin Ozturk P, Ozel M, Arac S, Evran S, Cevik S, et al.

In this study, we aimed to evaluate the use of the Rotterdam scale on pediatric trauma patients in our country and assess its relationship with lesion type, location and severity, trauma type, and need for surgery.

Key Study: Comparison of minor head trauma management in the emergency departments of a United States and Italian Children's hospital.

Visit

Stopa BM, Amoroso S, Ronfani L, Neri E, Barbi E, Lee LK.

Pediatric head trauma management varies between emergency departments globally. Here we aim to compare the pediatric minor head trauma management between a US and Italian hospital.

Key Study: The Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in severe traumatic brain injury: a single-centre hybrid implementation and effectiveness study.

Visit

Vavilala MS, King MA, Yang JT, Erickson SL, Mills B, Grant RM, et al

As far as we know, there are no tested in-hospital care programmes for paediatric traumatic brain injury. We aimed to assess implementation and effectiveness of the Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in children with severe traumatic brain injury.

Key Study: Presenting characteristics associated with outcome in children with severe traumatic brain injury: a secondary analysis from a randomized, controlled trial of therapeutic hypothermia.

Visit

Rosario BL, Horvat CM, Wisniewski SR, Bell MJ, Panigrahy A, Zuccoli G, et al.

To identify injury patterns and characteristics associated with severe traumatic brain injury course and outcome, within a well-characterized cohort, which may help guide new research and treatment initiatives.

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: Assessment of non-routine events and significant physiological disturbances during emergency department evaluation after pediatric head trauma.

Visit

Alberto EC, Harvey AR, Amberson MJ, Zheng Y, Thenappan AA, Oluigbo C, et al

The purpose of this study was to determine the association of non-routine events (NREs) during the initial resuscitation phase with these physiological disturbances.

Key Study: Intracranial pressure monitoring associated with increased mortality in pediatric brain injuries.

Visit

Delaplain PT, Grigorian A, Lekawa M, Mallicote M, Joe V, Schubl SD, et al.

Utilization of ICP monitors for pediatric patients is low and varies between centers. We hypothesized that in more severely injured patients (GCS 3-4), there would be a decreased mortality associated with invasive monitoring devices.

Key Study: Computed tomography practice standards for severe pediatric traumatic brain injury in the emergency department: a national survey.

Visit

Yoo G, Leach A, Woods R, Holt T, Hansen G.

Acute medical management of traumatic brain injury (TBI) can be challenging outside of the resuscitation bay, specifically while obtaining a computed tomography (CT) scan of the brain. We sought out to determine the management practices of Canadian traumatologists for pediatric patients with severe TBI requiring CT in the emergency department.

Key Study: The use of Rotterdam CT score for prediction of outcomes in pediatric traumatic brain injury patients admitted to emergency service.

Visit

Katar S, Aydin Ozturk P, Ozel M, Arac S, Evran S, Cevik S, et al.

In this study, we aimed to evaluate the use of the Rotterdam scale on pediatric trauma patients in our country and assess its relationship with lesion type, location and severity, trauma type, and need for surgery.

Key Study: Comparison of minor head trauma management in the emergency departments of a United States and Italian Children's hospital.

Visit

Stopa BM, Amoroso S, Ronfani L, Neri E, Barbi E, Lee LK.

Pediatric head trauma management varies between emergency departments globally. Here we aim to compare the pediatric minor head trauma management between a US and Italian hospital.

Key Study: The Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in severe traumatic brain injury: a single-centre hybrid implementation and effectiveness study.

Visit

Vavilala MS, King MA, Yang JT, Erickson SL, Mills B, Grant RM, et al

As far as we know, there are no tested in-hospital care programmes for paediatric traumatic brain injury. We aimed to assess implementation and effectiveness of the Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in children with severe traumatic brain injury.

Key Study: Presenting characteristics associated with outcome in children with severe traumatic brain injury: a secondary analysis from a randomized, controlled trial of therapeutic hypothermia.

Visit

Rosario BL, Horvat CM, Wisniewski SR, Bell MJ, Panigrahy A, Zuccoli G, et al.

To identify injury patterns and characteristics associated with severe traumatic brain injury course and outcome, within a well-characterized cohort, which may help guide new research and treatment initiatives.

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

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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

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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

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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

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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

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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

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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

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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?

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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Emergency Medicine Cases Podcast: Pediatric Trauma

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Dr. Sue Beno, Dr. Faud Alnaji

Management of the pediatric trauma patient is challenging regardless of where you work. In this EM Cases episode, two leading pediatric trauma experts, Dr. Sue Beno from Hospital for Sick Children in Toronto and Dr. Faud Alnaji from Children’s Hospital of Eastern Ontario in Ottawa answer such questions as: what are the most important physiologic and anatomic differences between children and adults that are key to managing the trauma patient? How much fluid should be given prior to blood products? What is the role of POCUS in abdominal trauma? Which patients require abdominal CT?

Emergency Medicine Cases Podcast: Pediatric Trauma

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Dr. Sue Beno, Dr. Faud Alnaji

Management of the pediatric trauma patient is challenging regardless of where you work. In this EM Cases episode, two leading pediatric trauma experts, Dr. Sue Beno from Hospital for Sick Children in Toronto and Dr. Faud Alnaji from Children’s Hospital of Eastern Ontario in Ottawa answer such questions as: what are the most important physiologic and anatomic differences between children and adults that are key to managing the trauma patient? How much fluid should be given prior to blood products? What is the role of POCUS in abdominal trauma? Which patients require abdominal CT?