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TBI and Kids: New Treatment Guidelines Issued

Third-edition seeks to improve mortality rates for severe pediatric traumatic brain injury

Each year, approximately 500,000 children are admitted to emergency rooms due to a traumatic brain injury (TBI), or a disruption to the normal function of the brain caused by a bump, blow or jolt to the head. TBI can cause long-term health conditions such as seizures, learning difficulty and communication disorders; some of the most severe cases may result in death.

To help promote the highest standards of care, and improve the overall rates of survival and recovery following TBI, a panel of neurosurgery, critical care, and pediatric experts issued the 3rd edition of the Brain Trauma Foundation Guidelines for the Management of Pediatric Severe TBI.

The updated guidelines reflect the addition of nearly 50 research studies including research carried out at University of Utah Health and Primary Children’s Hospital examining practices surrounding a range of medical conditions from seizures to hyperglycemia to intracranial hypertension. Active U of U Health faculty who contributed to this work include Gitte Larsen, M.D, MPH, professor of Pediatrucs, Eric Scaife, M.D., professor of Surgery, Douglas Brockmeyer M.D., professor of Neurosurgery, N. Clay Mann, Ph.D., professor of Pediatrics, Kevin Moore, M.D., adjunct professor in Radiology and Imaging Sciences, and Eliotte Hirschberg, M.D., associate professor of Internal Medicine.

This newest version guidelines include eight new, or revised, treatment recommendations for health care providers that range from the use of intracranial monitoring to the use of hypertonic saline to reduce acute brain swelling.

An executive summary of the guideline today published in the journals Pediatric Critical Care Medicine and Neurosurgery; the full guidelines are available via Pediatric Critical Care Medicine.

“These guidelines are important because they standardize care and point out where research is lacking,” said co-author Susan Bratton, M.D., professor emeritus of pediatrics at U of U Health. She points out that head injuries are the most common cause of death among people ages 2 to 45. Over the years, the guidelines have helped establish that children with severe head injuries require different treatment than adults. “Children are not small adults and one thing the guidelines do is reflect that important fact.”

“The Brain Trauma Foundation’s severe brain injury management guidelines have been instrumental in improving care and reducing variability in care around the world,” says co-author and U of U Health neurosurgeon Gregory Hawryluk, M.D., Ph.D. “By some estimates implementation of the guidelines has reduced mortality from severe TBI by as much as 50 percent.”

An associated manuscript also published in Pediatric Critical Care Medicine, describes an algorithm designed to guide first and second tier therapies for infants and children with severe TBI. The tool, which supplements evidence-based recommendations in the updated guidelines, was created using a validated, consensus-based expert opinion process.

“We believe a combination of research findings and real-life experience will further advance the bedside care of infants and children with severe TBI, especially in treatment scenarios where scientific and clinical research is lacking,” said first author Patrick Kochanek, M.D., Professor and Vice Chairman of Critical Care Medicine and Director of the Safar Center for Resuscitation Research at the University of Pittsburgh. “This algorithm will also help to identify key research priorities to help ensure the ongoing momentum of consistent, high-quality care for patients across the globe.”

The original Brain Trauma Foundation Guidelines published in 2003 and were last updated in 2012. The 3rd edition was developed as part of the Brain Trauma Evidence-based Consortium based at the Stanford University School of Medicine. The Pacific Northwest Evidence-based Practice Center at OHSU managed the effort, which included experts from U of U Health, OHSU, the University of Pittsburgh, Boston Children’s Hospital, Phoenix Children’s Hospital, Children’s National Medical Center, the University of British Columbia, and Duke University.

This work was funded by the U.S. Army Contracting Command, Aberdeen Proving Ground, Natick Contracting Division. Prior editions were supported by funding from multiple sources through the Brain Trauma Foundation.