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Patients and Family Resources

all patients and families resources



Resources in Evidence Repository and Individual Compendia

Bottom Line Recommendations

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.

Bottom Line Recommendations: Severe Head Injury

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Beno S & TREKK Network

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

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 Recommenation: Optimal pain relief for pediatric MSK injury.

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Korownyk C, Young J, Michael Allan G

Evidence suggests that ibuprofen provides better single-agent relief than acetaminophen or codeine, and is at least equivalent to both acetaminophen with codeine and morphine for acute injury pain, with fewer adverse events.

Recommendations de Base: Traumatisme Cranien Severe

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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.

Clinical guidelines

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: 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.

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

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Da Dalt L, Parri N, Amigoni A, 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: 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: Management of Pediatric Supracondylar Humerus Fractures with Vascular Injury

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Sanders JO, Heggeness MH, Murray JN, Pezold RC, Sevarino KS

Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions for pediatric supracondylar humerus fractures with vascular injury.

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.

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

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Lumba-Brown A, Yeates KO, Sarmiento K, et al.

Based on a previous systematic review of the literature, this guideline includes 19 sets of recommendations on diagnosis, prognosis, and management/treatment of pediatric mTBI. Each recommendation was assigned a level of obligation (ie, must, should, or may) based on confidence in the evidence.

Summaries of systematic reviews

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

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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

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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

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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

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Alderson P, Roberts I

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

Overviews of systematic reviews

Blood-clot promoting drugs for acute traumatic injury

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Ker K, Robert, I, Shakur H, Coats TJ,

This is an update of an existing Cochrane review, the last version was published in 2012.

No evidence in favour of using ultrasound to aid diagnosis of patients with a 'blunt' injury to the abdomen

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Stengel D, Bauwens K, Rademacher G, Ekkernkamp A, Gthoff C,

This Cochrane Review may be regarded as a review which provides the best available evidence for clinical practice guidelines and management recommendations.

Regular or selected use of computed tomography (CT) scanning to reduce deaths in people who have a high-energy blunt-traumatic injury

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Van Vugt R, Keus F, Kool D, Deunk J, Edwards M,

We searched medical databases for publications of randomised controlled trials (a clinical study where participants are randomly allocated into treatment groups) comparing the usual approach versus selected use of CT scanning.

Systematic reviews

Systematic Review: Hypothermia for traumatic head injury

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Sydenham E, Roberts I, Alderson P

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

Cochrane Systematic Review: Interventions for treating head lice

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Dodd CS

OBJECTIVES: The aim of this review was to assess the effects of interventions for head lice.

Systematic Review: Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review

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Maguire SA, Watts PO, Shaw AD, Holden S, Taylor RH, Watkins WJ, Mann MK, Temp...

Aim: To report the retinal signs that distinguish abusive head trauma (AHT) from non-abusive head trauma (nAHT).

Systematic Review: Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review

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Piteau SJ, Ward MG, Barrowman NJ, Plint AC

Objective: To systematically review the literature to determine which clinical and radiographic characteristics are associated with abusive head trauma (AHT) and nonabusive head trauma (nAHT) in children.

Systematic Review: Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma?

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Kemp AM, Jaspan T, Griffiths J, Stoodley N, Mann MK, Tempest V, Maguire SA

Objective: To identify the evidence base behind the neuroradiological features that differentiate abusive head trauma (AHT) from non-abusive head trauma (nAHT).

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

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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.

Review: Emergency Medicine Myths: Computed Tomography of the Head Prior to Lumbar Puncture in Adults with Suspected Bacterial Meningitis - Due Diligence or Antiquated Practice?

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April MD, Long B, Koyfman A

Objective: To review the evidence regarding the utility of obtaining head CT prior to lumbar puncture in adults with suspected bacterial meningitis.

Cochrane Systematic Review: Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

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Afshari A, Brok J, Mller AM, Wetterslev J

OBJECTIVES: To systematically assess the benefits and harms of aerosolized prostacyclin in critically ill patients with ALI and ARDS.

Cochrane Systematic Review: High-frequency ventilation versus conventional ventilation for treatment of acute lung injury and acute respiratory distress syndrome

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Sud S, Sud M, Friedrich JO, Wunsch H, Meade MO, Ferguson ND, Adhikari NK

OBJECTIVES: To determine clinical and physiological effects of high frequency oscillation (HFO) in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) compared to conventional ventilation.

Cochrane Systematic Review: Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) and acute lung injury in children and adults

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Afshari A, Brok J, Mller AM, Wetterslev J. Inhaled nitric oxide for acute re...

OBJECTIVES: To systematically assess the benefits and harms of INO in critically ill patients with AHRF.

Cochrane Systematic Review: Antifibrinolytic drugs for acute traumatic injury

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Roberts I, Shakur H, Ker K, Coats T; CRASH-2 Trial collaborators

OBJECTIVES: To quantify the effects of antifibrinolytic drugs on mortality, vascular occlusive events, surgical intervention and receipt of blood transfusion after acute traumatic injury.

Cochrane Systematic Review: Bradykinin beta-2 receptor antagonists for acute traumatic brain injury

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Ker K, Blackhall K

OBJECTIVES: The objective was to assess the safety and effectiveness of beta-2 receptor antagonists for TBI.

Cochrane Systematic Review: Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury

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Sahuquillo J, Arikan F

OBJECTIVES: To assess the effects of secondary decompressive craniectomy (DC) on outcome and quality of life in patients with severe TBI in whom conventional medical therapeutic measures have failed to control raised ICP.

Cochrane Systematic Review: Excitatory amino acid inhibitors for traumatic brain injury

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Willis C, Lybrand S, Bellamy N

OBJECTIVES: To assess systematically the efficacy of excitatory amino acid inhibitors on improving patient outcome following traumatic brain injury.

Cochrane Systematic Review: Hyperventilation therapy for acute traumatic brain injury

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Schierhout G, Roberts I

OBJECTIVES: To quantify the effect of hyperventilation on death and neurological disability following head injury.

Cochrane Systematic Review: Pharmacological interventions for spasticity following spinal cord injury

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Taricco M, Adone R, Pagliacci C, Telaro E

OBJECTIVES: To assess the effectiveness and safety of Baclofen, Dantrolene, Tizanidine and any other drugs for the treatment of long term spasticity in SCI patients as well as the effectiveness and safety of different routes of administration of Baclofen.

Cochrane Systematic Review: Progesterone for acute traumatic brain injury

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Ma J, Huang S, Qin S, You C

OBJECTIVES: To assess the effectiveness and safety of progesterone in people with acute TBI.

Cochrane Systematic Review: Steroids for acute spinal cord injury

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Bracken MB

OBJECTIVES: To review randomized trials of steroids for human acute spinal cord injury.

Cochrane Systematic Review: Primary closure versus delayed closure for non bite traumatic wounds within 24 hours post injury

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Eliya-Masamba MC, Banda GW

OBJECTIVES: To determine the effect on time to healing of primary closure versus delayed closure for non bite traumatic wounds presenting within 24 hours post injury. To explore the adverse effects of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours post injury.

Systematic Review: Haemostatic drugs for traumatic brain injury

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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

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Alderson P, Roberts I

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

Systematic Review: What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review

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Kemp AM, Rajaram S, Mann M, Tempest V, Farewell D, Gawne-Cain ML, Jaspan T, M...

Aim: To investigate the optimal neuroradiological investigation strategy to identify inflicted brain injury (iBI).

Systematic Review: Which clinical features distinguish inflicted from non-inflicted brain injury? A systematic review

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Maguire S, Pickerd N, Farewell D, Mann M, Tempest V, Kemp AM

Aim: A systematic review of the scientific literature to define clinical indicators distinguishing inflicted (iBI) from non-inflicted brain injury (niBI).

Antifibrinolytic drugs for acute traumatic injury

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Ker K, Roberts I, Shakur H, Coats TJ,

Review to assess the effect of antifibrinolytic drugs in patients with acute traumatic injury.

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

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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

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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: Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review.

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Le May S,Ali S,Khadra C,Drendel AL,Trottier ED,Gouin S,Poonai N.

Objective. To systematically review the most effective pain management for children presenting to the emergency department with musculoskeletal injuries.

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

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Appenteng R, Nelp T, Abdelgadir J, et al.

Traumatic brain injuries (TBI) are a significant cause of mortality and morbidity for children globally. Adherence to evidence-based treatment guidelines have been shown to improve TBI outcomes. 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: A systematic review of sleep-wake disturbances in childhood traumatic brain injury: relationship with fatigue, depression, and quality of life

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Botchway EN, Godfrey C, Anderson V, Catroppa C.

Objective: To systematically appraise the literature on the prevalence, types, and predictors of sleep-wake disturbances (SWD), and on the relationship between SWD, fatigue, depression, and quality of life in children and adolescents with traumatic brain injury (TBI).

Systematic review: Diagnosis and management of mild traumatic brain injury in children: a systematic review

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Lumba-Brown A, Yeates KO, Sarmiento K, et al.

Objective: To conduct a systematic review of the pediatric mTBI literature to serve as the foundation for an evidence-based guideline with clinical recommendations associated with the diagnosis and management of pediatric mTBI.

Systematic review: Pediatric traumatic brain injury and antisocial behavior: are they linked? A systematic review

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Bellesi G, Barker ED, Brown L, Valmaggia L.

This review aimed to explore systematically previous literature on the association between TBI before the age of 19 and severe behavioral problems such as violence, aggression and assault.

Systematic review: Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery

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Luther M, Poppert Cordts KM, Williams CN

Objectives: Sleep is vital for brain development and healing after injury, placing children with sleep-wake disturbances (SWD) after traumatic brain injury (TBI) at risk for worse outcomes. We conducted a systematic review to quantify SWD after pediatric TBI including prevalence, phenotypes, and risk factors. We also evaluated interventions for SWD and the association between SWD and other posttraumatic outcomes.

Cochrane Systematic Review: Hypothermia for neuroprotection in children after cardiopulmonary arrest

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Scholefield B, Duncan H, Davies P, Gao Smith F, Khan K, Perkins GD, Morris K

OBJECTIVES: To assess the clinical effectiveness of therapeutic hypothermia after paediatric cardiopulmonary arrest.

Key studies

Key Study: Prospective validation and head-to-head comparison of 3 ankle rules in a pediatric population

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Gravel, J, Hedrei, P, Grimard, G & Gouin, S

Objective: To determine the criterion validity of three rules for predicting clinically important ankle fractures in children.

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: Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study

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Easter JS, Bakes K, Dhaliwal J, Miller M, Caruso E, Haukoos JS

Objective: To evaluate the diagnostic accuracy of clinical decision rules and physician judgment for identifying clinically important traumatic brain injuries in children with minor head injuries presenting to the emergency department.

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: Delayed presentations to emergency departments of children with head injury: A PREDICT Study

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Borland ML, Dalziel SR, Phillips N, et al.

Objective: Existing clinical decision rules guide management for head-injured children presenting 24 hours or sooner after injury, even though some may present greater than 24 hours afterward. We seek to determine the prevalence of traumatic brain injuries for patients presenting to emergency departments greater than 24 hours after injury and identify symptoms and signs to guide management.

Key study: Effect of cognitive and physical rest on persistent postconcussive symptoms following a pediatric head injury

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Root JM, Sady MD, Gai J, Vaughan CG, Madati PJ

To evaluate the effect of cognitive and physical rest on persistent postconcussive symptoms in a pediatric population.

Key study: Pediatric minor head injury imaging practices: results from an ESPR survey

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Argyropoulou MI, Alexiou GA, Xydis VG, et al.

Objective: Computed tomography (CT) for minor head injury exposes a large number of children to ionizing radiation, with an associated increased lifetime risk of malignancy. To study imaging practices for children with minor head injury and the level of awareness of radiologists of the current clinical decision rules for minor traumatic brain injury (TBI).

Key study: Reduction of computed tomography use for pediatric closed head injury evaluation at a nonpediatric community emergency department

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Puffenbarger MS, Ahmad FA, Argent M, Gu H, Samson C, Quayle KS, Saito JM.

The purpose of this study was to determine if implementation of a Pediatric Emergency Care Applied Research Network (PECARN)-based Closed Head Injury Assessment Tool could safely decrease computed tomography (CT) use for pediatric head injury evaluation at a nonpediatric community emergency department (ED).

Outcomes of management in stable children with intra-abdominal free fluid without solid organ injury after blunt abdominal injury

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Venkatesh KR, McQuay N Jr,

The charts of all children less than 18 years of age who had an abdominopelvic CT scan after a blunt abdominal trauma between January 2001 and July 2004 were queried.

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: Validation of a clinical prediction rule for pediatric abusive head trauma

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Hymel KP, Armijo-Garcia V, Foster R, Frazier TN, Stoiko M, Christie LM, Harpe...

To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population.

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.

Key Study: Prior opportunities to identify abuse in children with abusive head trauma

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Letson MM, Cooper JN, Deans KJ, Scribano PV, Makoroff KL, Feldman KW, Berger RP

Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities.

Key Study: Abusive head trauma: recognition and the essential investigation

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Kemp AM

This article describes the evidence base behind the associated historical, clinical and neuroradiological features of abusive head trauma and spinal injury in physical abuse and sets out an algorithm of essential investigations that should be performed in any infant or young child where abusive head trauma is suspected.

Key Study: Analysis of missed cases of abusive head trauma

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Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC

Objectives: To determine how frequently AHT was previously missed by physicians in a group of abused children with head injuries and to determine factors associated with the unrecognized diagnosis.

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: 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: 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: 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: Effectiveness of oxycodone, ibuprofen, or the combination in the initial management of orthopedic injury-related pain in children

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Koller DM, Myers AB, Lorenz D, Godambe SA

Objective: Orthopedic injuries comprise a majority of the indications for analgesia in the emergency department. Oxycodone and ibuprofen have demonstrated efficacy for this indication, but no studies have compared these drugs in children. Our objective was to investigate the effectiveness of oxycodone, ibuprofen, or their combination for the management of orthopedic injury-related pain in children.

Key Study: Child abuse and orthopaedic injury patterns:analysis at a level I pediatric trauma center

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Pandya NK, Baldwin K, Wolfgruber H, Christian CW, Drummond DS, Hosalkar HS

The purpose of our study was to describe the patterns of orthopaedic injury for child abuse cases detected in the large urban area that our institution serves, and to compare the injury profiles of these victims of child abuse to that of general (accidental) trauma patients seen in the emergency room and/or hospitalized during the same time period.

Key Study: Epidemiology of Injury-Related Emergency Department Visits in the US Among Youth with Autism Spectrum Disorder

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Kalb LG, Vasa RA, Ballard ED, Woods S, Goldstein M, Wilcox HC

This study aims to use nationally-representative emergency department data to characterize injury-related ED visits among youth with autism spectrum disorder.

Key Study: Injury treatment among children with autism or pervasive developmental disorder

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McDermott S, Zhou L, Mann J

This study examined the difference in the frequency and type of injury for children with autism and pervasive developmental disorder compared with typically developing peers.

Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC+ prospective study

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Magoteaux SR, Notrica DM, Langlais CS, Linnaus ME, Raines AR, Letton RW, Alde...

This study sought to determine the relationship between early transfusion in pediatric BLSI and hypotension.

Predictors of Intrathoracic Injury after Blunt Torso Trauma in Children Presenting to an Emergency Department as Trauma Activations

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McNamara C, Mironova I, Lehman E, Olympia RP,

Retrospective chart review to identify predictors of thoracic injury in children presenting as trauma activations to a Level I trauma center after blunt torso trauma, and to compare these predictors with those previously reported in the literature.

Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely

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Streck CJ, Vogel AM, Zhang J, Huang EY, Santore MT, Tsao K, Falcone RA, Dassi...

Prospective study to derive a prediction rule to identify children at very low risk for IAI after blunt abdominal trauma (BAT) for whom a CT scan of the abdomen would be unnecessary.

Predicting Thoracic Injury in Children With Multitrauma

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Weerdenburg KD, Wales PW, Stephens D, Beno S, Gantz J, Alsop J, Schuh S,

This study was a retrospective trauma registry analysis of previously healthy children aged 0 to 17 years with multisystem blunt trauma requiring trauma team activation and chest radiography who were divided into those with and without TI.

Variability of prehospital spinal immobilization in children at risk for cervical spine injury

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Kim EG, Brown KM, Leonard JC, Jaffe DM, Olsen CS, Kuppermann N, C-Spine Study...

We compared prehospital spinal immobilization in 3 age-based cohorts of children with blunt trauma-related CSI transported to 1 of 17 participating hospitals.

Evaluation for intra-abdominal injury in children after blunt torso trauma: can we reduce unnecessary abdominal computed tomography by utilizing a clinical prediction model?

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Streck CJ Jr, Jewett BM, Wahlquist AH, Gutierrez PS, Russell WS,

A retrospective chart review of all blunt "trauma alerts" for patients younger than 16 years during an 18-month period was performed at a Level I trauma center.

Complications of nonoperative management of pediatric blunt hepatic injury: Diagnosis, management, and outcomes

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Giss SR, Dobrilovic N, Brown RL, Garcia VF,

A retrospective study of pediatric patients with blunt hepatic injuries admitted from 1991 through 1997 to a Level I pediatric trauma center was conducted.

The failure of nonoperative management in pediatric solid organ injury: a multi-institutional experience

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Holmes JH 4th, Wiebe DJ, Tataria M, Mattix KD, Mooney DP, Scaife ER, Brown RL...

A retrospective analysis was performed from January 1997 through December 2002 of all pediatric patients (age 0-20 years) with a SOI (liver, spleen, kidney, pancreas) from the trauma registries of seven designated, level I pediatric trauma centers.

Association between the "seat belt sign" and intra-abdominal injury in children with blunt torso trauma

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Sokolove PE, Kuppermann N, Holmes JF,

The authors performed a prospective, observational study of children at risk for IAI who presented to a Level 1 trauma center following a motor vehicle collision (MVC) during a two-year period.

Key Study: A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules

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Slaar A, Walenkamp MM, Bentohami A, Maas M, van Rijn RR, Steyerberg EW, Jager...

The objective of this study was to develop and validate a clinica decision rule to decide whether radiography in children with wrist trauma is required.

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: 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: Oral Analgesics Utilization for Children With Musculoskeletal Injury (OUCH Trial): An RCT

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Le May S, Ali S, Plint AC, Msse B, Neto G, Auclair MC, Drendel AL, Ballard A,...

We aimed to test the efficacy of a combination of an anti-inflammatory drug with an opioid for pain management of MSK-I in children presenting to the ED.

Key study: Admission of pediatric concussion injury patients: is it necessary?

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Lindholm EB, DCruz R, Fajardo R, et al.

The purpose of this study was to determine if pediatric patients evaluated in the emergency department (ED) for concussion with a negative head CT scan require routine hospital admission.

Key study: Association of time since injury to the first clinic visit with recovery following concussion

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Kontos AP, Jorgensen-Wagers K, Trbovich AM, et al.

To investigate the association of time since injury with initiation of clinical care on recovery time following concussion.

Key study: Early versus delayed emergency department presentation following mild traumatic nrain injury and the presence of symptom at 1, 4 and 12 weeks in children

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Gravel J, Ledoux AA, Tang K, et al.

We evaluated the association between timing of presentation and postconcussive symptoms (PCS) at 1, 4 and 12 weeks after injury.

Key study: MRI in mild pediatric traumatic brain injury: diagnostic overkill or useful tool?

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Cohrs, G., Huhndorf, M., Niemczyk, N. et al.

Magnetic resonance imaging (MRI) is a sensitive imaging tool which lacks the burden of ionizing radiation. It is not established as primary diagnostic tool in traumatic brain injury (TBI). The purpose of this study was to evaluate the usefulness of MRI as initial imaging modality in the emergency management of mild pediatric TBI.

Key study: Physical activity after mild traumatic brain injury: what are the relationships with fatigue and sleep quality?

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van Markus-Doornbosch F, Peeters E, van der Pas S, Vlieland TV, Meesters J.

To determine self-reported physical activity (PA) levels and relationships with fatigue and sleep quality in adolescents and young adults after mild traumatic brain injury (mTBI).

Key study: Practice patterns in pharmacological and non-pharmacological therapies for children with mild traumatic brain injury: a survey of 15 canadian and United States centers

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Mannix R, Zemek R, Yeates KO, et al.

Given the lack of evidence regarding effective pharmacological and non-pharmacological interventions for pediatric mild traumatic brain injury (mTBI) and the resultant lack of treatment recommendations reflected in consensus guidelines, variation in the management of pediatric mTBI is to be expected. We therefore surveyed practitioners across 15 centers in the United States and Canada who care for children with pediatric mTBI to evaluate common-practice variation in the management of pediatric mTBI.

Key study: Risk factors for prolonged symptoms of mild traumatic brain injury: a pediatric sports concussion clinic cohort

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Fehr SD, Nelson LD, Scharer KR, et al.

To examine predictors of prolonged symptom duration from mild traumatic brain injury (mTBI) in a pediatric sports medicine specialty clinic cohort as these predictors may be distinct in this population.

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: 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: 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: 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: 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.

TREKK.ca Info Pages

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Brain Injury Awareness month

Posted: Jun 06, 2017  | Announcement  | Team: News and Events 



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Brain Injury Awareness Month 2019

Posted: Jun 13, 2019  | Announcement  | Team: News and Events 



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Brain Awareness Week

Posted: Mar 11, 2019  | Announcement  | Team: News and Events 



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Brain Awareness Week

Posted: Mar 15, 2021  | Announcement  | Team: News and Events 



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Predicting the duration of post-concussion symptoms

Posted: Mar 10, 2016  | Announcement  | Team: News and Events 



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New Podcast: Pediatric Physical Abuse Recognition and Management

Posted: Mar 27, 2018  | Announcement  | Team: News and Events 



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Congratulations Dr. Klassen

Posted: Aug 08, 2014  | Announcement  | Team: News and Events 



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New Resources for Multisystem Trauma

Posted: Jul 14, 2020  | Announcement  | Team: News and Events 



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New resources available on trekk.ca!

Posted: Jul 10, 2015  | Resource  | Team: News and Events 



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NEW Burns Bottom Line Recommendations

Posted: Feb 23, 2021  | Announcement  | Team: News and Events 



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Concussion Study

Posted: Apr 26, 2021  | Announcement  | Team: News and Events 



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TREKK Board Announcement

Posted: May 21, 2019  | Announcement  | Team: News and Events 



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TREKK at CAEP 2018

Posted: Feb 06, 2018  | Announcement  | Team: News and Events 




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