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Review
. 2025 Feb;46(2):969-991.
doi: 10.1007/s10072-024-07849-2. Epub 2024 Oct 30.

Management of severe traumatic brain injury in pediatric patients: an evidence-based approach

Ana Paula de Carvalho Panzeri Carlotti  1 , Vivian Henriques do Amaral  2 , Ana Paula de Carvalho Canela Balzi  2 , Cintia Johnston  3 , Fabiane Allioti Regalio  2 , Maíra Freire Cardoso  2 , Juliana Ferreira Ferranti  3 , Patrícia Zamberlan  3 , Alfredo Elias Gilio  4 , Luiz Marcelo Sá Malbouisson  2 , Artur Figueiredo Delgado  3 , Werther Brunow de Carvalho  3 ; Brazilian Pediatric Intensive Care Group
Collaborators, Affiliations
Review

Management of severe traumatic brain injury in pediatric patients: an evidence-based approach

Ana Paula de Carvalho Panzeri Carlotti et al. Neurol Sci. 2025 Feb.

Abstract

Background: Traumatic brain injury (TBI) is a major cause of death and disability worldwide. The decision-making process in the management of severe TBI must be based on the best available evidence to minimize the occurrence of secondary brain injuries. However, healthcare approaches to managing TBI patients exhibit considerable variation.

Methods: Over an 18-month period, a multidisciplinary panel consisting of medical doctors, physiotherapists, nutritional therapists, and nurses performed a comprehensive review on various subtopics concerning TBI. The panel identified primary questions to be addressed using the Population, Intervention, Control, and Outcome (PICO) format and applied the Evidence to Decision (EtD) framework criteria for evaluating interventions. Subsequently, the panel formulated recommendations for the management of severe TBI in children.

Results: Fourteen evidence-based recommendations have been devised for the management of severe TBI in children, covering nine topics, including imaging studies, neuromonitoring, prophylactic anticonvulsant use, hyperosmolar therapy, sedation and analgesia, mechanical ventilation strategies, nutritional therapy, blood transfusion, and decompressive craniectomy. For each topic, the panel provided clinical recommendations and identified research priorities.

Conclusions: This review offers evidence-based strategies aimed to guide practitioners in the care of children who suffer from severe TBI.

Keywords: Evidence-based; Management; Monitoring; Traumatic brain injury.

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Conflict of interest statement

Declarations: We confirm that the manuscript complies with all instructions to authors. We confirm that authorship requirements have been met and the final manuscript was approved by all authors. We confirm that this manuscript has not been published elsewhere and is not under consideration by another journal. We used the AGREE checklist for this manuscript. Ethical approval: Ethics approval for this study does not apply because it does not involve any data from human or animal participants. Conflict of interest: The authors have no conflicts of interest to disclose.

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