Prehospital and emergency management of pediatric traumatic brain injury: a multicenter site survey-Reference-Cited by-同舟云学术

Prehospital and emergency management of pediatric traumatic brain injury: a multicenter site survey

Published:2023-03-01 Issue: Volume: Page:1-9
ISSN:1933-0707
Container-title:Journal of Neurosurgery: Pediatrics
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Author:

Mai Gawin¹,Lee Jan Hau²,Caporal Paula³⁴,Roa G. Juan D.⁴⁵,González-Dambrauskas Sebastián⁴⁶,Zhu Yanan⁷,Yock-Corrales Adriana⁸,Abbas Qalab⁹,Kazzaz Yasser¹⁰¹¹,Dewi Dianna Sri¹²,Chong Shu-Ling¹³,_ _,Turina Deborah M.¹⁴¹⁵,Domínguez-Rojas Jesús A.¹⁶¹⁷,Pilar-Orive Francisco J.¹⁸,Gan Chin Seng¹⁹,Abbas Qalab⁹,Villalobos Willmer E. Diaz²⁰,Ardila Ivan J.²¹,Samransamruajkit Rujipat²²,Yock-Corrales Adriana²³,Fonseca Marisol²⁴,Aparicio Gabriela²⁵,Jaramillo-Bustamante Juan C.²⁶,Lee Pei-Chuen²⁷,Teran Thelma E.²⁸,Monteverde-Fernandez Nicolas²⁹,Rodríguez María Miñambres³⁰,Roa G Juan D.³¹,Liu Chunfeng³²,Zhang Tao³²,Ming Meixiu³³,Dang Hongxing³⁴,Kurosawa Hiroshi³⁵,Chamorro Freddy Israel Pantoja³⁶³⁷,Noguera Deiby Lasso³⁶,Cerón Esteban³⁶,Arriola Natalia Gómez³⁸,Palomino Ruben Eduardo Lasso³⁹

Affiliation:

1. Duke-NUS Medical School, Singapore;

2. Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, SingHealth Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore;

3. Pediatric Intensive Care Unit, Children’s Hospital "Sor Maria Ludovica," Buenos Aires, Argentina;

4. Pediatric Collaborative Latin American Network (LARed Network);

5. Pediatric Intensive Care Unit, Los Cobos Medical Center, Universidad del Bosque, Bogotá, Colombia;

6. Department of Pediatrics and Pediatric Intensive Care Unit, Hospital Pereira Rossell, School of Medicine, University of the Republic, Montevideo, Uruguay;

7. Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore;

8. Emergency Department, National Children’s Hospital "Dr. Carlos Saenz Herrera," CCSS, San José, Costa Rica;

9. Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan;

10. Department of Paediatrics, Ministry of National Guards Health Affairs, Riyadh, Saudi Arabia;

11. King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia;

12. KK Research Centre, KK Women’s and Children’s Hospital, Singapore; and

13. Department of Emergency Medicine, KK Women’s and Children’s Hospital, SingHealth Paediatrics Academic Clinical Programme, SingHealth Emergency Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore

14. Pediatric Intensive Care Unit, Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina;

15. Master’s Degree Higher Education for Health Professionals, University Institute School of Medicine of the Italian Hospital (IUHI), Buenos Aires, Argentina;

16. Department of Pediatrics and Pediatric Critical Care Medicine, Hospital Nacional Hipolito Unanue, El Agustino, Peru;

17. Pediatric Chapter of the Peruvian Society of Intensive Care Medicine, Lima, Peru;

18. Pediatric Intensive Care Unit, Cruses University Hospital, Barakaldo, Bizkaia, Spain;

19. Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia;

20. Pediatric and Neonate Intensive Care Unit, Maternal and Child Hospital, La Paz, Bolivia;

21. Pediatric Critical Care, Clinica UROS, Neiva, Huila, Colombia;

22. Department of Pediatrics, Pediatric Critical Care Division, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand;

23. Department of Emergency Medicine, National Children’s Hospital "Dr. Carlos Saenz Herrera," San José, Costa Rica;

24. Pediatric Critical Care, Mexican Institute of Social Security, México City, Mexico;

25. Pediatric Critical Care Unit, HIAEP Sor María Ludovica, La Plata, Buenos Aires, Argentina;

26. Pediatric Intensive Care Unit, General Hospital of Medellín "Luz Castro de Gutiérrez," Medellín, Colombia;

27. Pediatrics Department, UKM Specialist Children’s Hospital, Kuala Lumpur, Wilayah Persekutuan, Malaysia;

28. Pediatric Intensive Care Unit, Children’s Hospital "Manuel Ascencio Villarroel," Cochabamba, Bolivia;

29. Critical Care Unit (CINP), Medica Uruguaya, Montevideo, Uruguay;

30. Pediatric Intensive Care Unit, Pediatrics Department, Virgen de la Arrixaca Hospital, Murcia, Spain;

31. Pediatrics Department, Misericordia Foundation Hospital, National University of Colombia, Bogota, Colombia;

32. Pediatric Department, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China;

33. Department of Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, Shanghai, China;

34. Department of Pediatric Intensive Care Unit, Children’s Hospital of Chongqing Medical University, Chongqing, China;

35. Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan;

36. Pediatric Intensive Care Unit, Children’s Hospital Los Angeles, Pasto, Colombia;

37. Pediatric Department, Universidad de Nariño, Pasto, Colombia;

38. Emergency Department, Hospital del Trauma, Asunción, Paraguay; and

39. Pediatric Intensive Care Unit, Fundación Valle del Lili Hospital, Cali, Valle del Cauca, Colombia.

Abstract

OBJECTIVE There is a paucity of information on pediatric traumatic brain injury (TBI) care in Asia and Latin America. In this study, the authors aimed to describe the clinical practices of emergency departments (EDs) participating in the Saline in Asia and Latin-America Neurotrauma in the Young (SALTY) study, by comparing designated trauma centers (DTCs) and nontrauma centers (NTCs) in their networks. METHODS The authors performed a site survey study on pediatric TBI management in the EDs in 14 countries. Two European centers joined other participating sites in Asia and Latin America. Questions were formulated after a critical review of current TBI guidelines and published surveys. The authors performed a descriptive analysis and stratified centers based on DTC status. RESULTS Of 24 responding centers (70.6%), 50.0% were DTCs, 70.8% had academic affiliations, and all centers were in urban settings. Patients were predominantly transferred to DTCs by centralized prehospital services compared to those sent to NTCs (83.3% vs 41.7%, p = 0.035). More NTCs received a majority of their patients directly from the trauma scene compared to DTCs (66.7% vs 25.0%, p = 0.041). Ten centers (41.7%) reported the use of a TBI management guideline, and 15 (62.5%) implemented CT protocols. Ten DTCs reported implementation of intervention strategies for suspected raised intracranial pressure (ICP) before conducting a CT scan, and 6 NTCs also followed this practice (83.3% vs 50.0%, p = 0.083). ED management for children with TBI was comparable between DTCs and NTCs in the following aspects: neuroimaging, airway management, ICP monitoring, fluid resuscitation, anticoagulant therapy, and serum glucose control. Hyperventilation therapy for raised ICP was used by 33.3% of sites. CONCLUSIONS This study evaluated pediatric TBI management and infrastructure among 24 centers. Limited differences in prehospital care and ED management for pediatric patients with TBI were observed between DTCs and NTCs. Both DTCs and NTCs showed variation in the implementation of current TBI management guidelines. There is an urgent need to investigate specific barriers to guideline implementation in these regions.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

Link

https://thejns.org/downloadpdf/journals/j-neurosurg-pediatr/aop/article-10.3171-2023.1.PEDS22456/article-10.3171-2023.1.PEDS22456.xml

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