Severe Head Injury

Bottom line recommendations for the treatment and management of severe head injury - French. Version 3.0 published online November 15, 2022.

Bottom line recommendations for severe head injury. Uploaded to the website on November 15, 2022. 

Bottom line recommendations for the treatment and management of severe head injury - French. Version 3.0 published online November 15, 2022.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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).

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

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

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

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

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.

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.

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.

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.

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.

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.

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

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).

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.

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

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).

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

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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

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

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.

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?