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

Abstract

Objective: 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.

Methods: These guidelines were commissioned by the Italian Society of Pediatric Emergency Medicine and include a systematic review and analysis of the literature published since 2005. Physicians with expertise and experience in the fields of pediatrics, pediatric emergency medicine, pediatric intensive care, neurosurgery and neuroradiology, as well as an experienced pediatric nurse and a parent representative were the components of the guidelines working group. Areas of direct interest included 1) initial assessment and stabilization in the ED, 2) diagnosis of clinically important traumatic brain injury in the ED, 3) management and disposition in the ED. The guidelines do not provide specific guidance on the identification and management of possible associated cervical spine injuries. Other exclusions are noted in the full text.

Conclusions: Recommendations to guide physicians practice when assessing children presenting to the ED following blunt head trauma are reported in both summary and extensive format in the guideline document.

Keywords: Children; Emergency department; Evidence-based; Guideline; Traumatic brain injury.

Fig. 1

Relationship of evidence quality and benefit-harm balance in determining the level of recommendation-[8]. Rec, recommendation

Fig. 2

PECARN algorithms for the emergency department management of minor head trauma – Adapted from [3]