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The following is a summary of “A Pediatric Brain Injury Guideline Allows Safe Management of Traumatic Brain Injuries by Trauma Surgeons,” published in the July 2024 issue of Pediatrics by McNickle et al.

Researchers introduced a Pediatric Brain Injury Guideline (pBIG) to stratify traumatic brain injuries (TBI) and manage less severe cases without requiring repeat CT imaging or neurosurgical consultation. TBIs were categorized into mild (pBIG1), moderate (pBIG2), severe (pBIG3), or isolated skull fractures (ISF) based on neurological status, size, and number of bleeds. The primary hypothesis was that pediatric TBIs could be managed safely using this guideline.

The study group analyzed data from the Pediatric Trauma Registry for isolated TBIs in patients under 18 years of age from July 2021 to March 2023, post-implementation of the pBIG. The dataset included patient age, injury specifics, repeat head CTs, neurosurgical consultations, and interventions. Statistical analysis was conducted using Stata, with significance at p<0.05.

The study included 139 children with a median age of 2.8 years. The most prevalent injuries were skull fractures (113 cases, 81%) and subdural hematomas (54 cases, 39%). Repeat head CTs were performed in 44 cases (32%), and neurosurgical consultation was sought in 89 cases (64%). Overall adherence to the guideline was 83.5%, with the highest compliance observed in the pBIG3 category (96%). One patient in the pBIG1 category experienced worsening symptoms necessitating an upgrade to pBIG2, a neurosurgical consultation, and a repeat head CT, though no surgical intervention was required. Post-discharge, five children (3.6%; four with isolated skull fractures and one with pBIG3) required emergency department visits, and one child (0.7%, ISF) underwent a post-discharge CT. Three children (2.2%) in the pBIG3 category died from their injuries.

Adherence to the pBIG algorithm was 83.5%, with the lowest compliance observed in the moderate TBI (pBIG2) category. This group demonstrated a higher rate of neurosurgical consultation, indicating potential discomfort with managing moderate injuries independently compared to minor TBIs or isolated skull fractures. Overall, the outcomes associated with the pBIG algorithm were deemed acceptable, validating its use for managing pediatric TBIs.

Source: sciencedirect.com/science/article/abs/pii/S0022346824004639