Adherence to Guidelines for Managing Severe Traumatic Brain Injury in Children.
Hengameh B Pajer, Anthony M Asher, Dennis Leung and 3 others
PMID 34467382WHAT IT FOUND
Nine pediatric severe TBI protocols varied from 2019 guidelines: all included normothermia and AEDs, none included coagulopathy treatment, and tiered ICP therapies differed.
It describes written protocols, not patient outcomes.
Key findings
01Nine institutional pediatric severe TBI protocols were reviewed and compared with the 2019 guidelines.
02Baseline interventions were inconsistently included: normothermia and AEDs at 9/9 institutions, but treatment of coagulopathy at 0/9.
03Tier 1 interventions were also variable: hypertonic saline at 8/9, CSF drainage at 4/9, neuromuscular blockade at 3/9, and maintenance of cerebral perfusion pressure at 2/9.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 9 of 24 contacted pediatric hospitals had protocols that could be reviewed; 10 did not reply or publish their protocols and 5 had no institutional protocol. The protocols were collected 1 month after the 2019 guidelines were published, so some differences may reflect time needed to update them. The small sample does not represent pediatric TBI practice across the US. Brain tissue partial pressure of oxygen and advanced neuromonitoring were excluded because inter-institutional variability was too high for analysis. The study compared written protocols only and reported no patient outcomes.
Declared interests
The paper reports NIH extramural research support. The supplied text does not include an author conflict-of-interest declaration.
The easy way to misread this
Do not conclude that following the 2019 pediatric severe TBI guidelines improves outcomes. This paper compared 9 written institutional protocols and reported no patient outcomes.