Differences in Medical Therapy Goals for Children With Severe Traumatic Brain Injury— An International Study
Published Date:Oct 2013
Source:Pediatr Crit Care Med. 2013; 14(8):811-818.
Corporate Authors:Multiple Medical Therapies for Pediatric Traumatic Brain Injury Workgroup
Pubmed Central ID:PMC4455880
Funding:U01 CE001630/CE/NCIPC CDC HHS/United States
R01 NS072308/NS/NINDS NIH HHS/United States
NS069247/NS/NINDS NIH HHS/United States
NS052478/NS/NINDS NIH HHS/United States
MH085722/MH/NIMH NIH HHS/United States
U01 NS081041/NS/NINDS NIH HHS/United States
MH56612/MH/NIMH NIH HHS/United States
R01 MH056612/MH/NIMH NIH HHS/United States
HD08003/HD/NICHD NIH HHS/United States
T32HD040686/HD/NICHD NIH HHS/United States
R10 MH056612/MH/NIMH NIH HHS/United States
Canadian Institutes of Health Research/Canada
U44 NS070324/NS/NINDS NIH HHS/United States
HD0499893/HD/NICHD NIH HHS/United States
R01 MH085722/MH/NIMH NIH HHS/United States
R01 NS069247/NS/NINDS NIH HHS/United States
F32 HD008003/HD/NICHD NIH HHS/United States
U01 NS052478/NS/NINDS NIH HHS/United States
NS072308/NS/NINDS NIH HHS/United States
T32 HD040686/HD/NICHD NIH HHS/United States
NS070324/NS/NINDS NIH HHS/United States
To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury.
A survey of the goals from representatives of the international centers.
Thirty-two pediatric traumatic brain injury centers in the United States, United Kingdom, France, and Spain.
Measurements and Main Results
A survey instrument was developed that required free-form responses from the centers regarding their usual practice goals for topics of intracranial hypertension therapies, hypoxia/ischemia prevention and detection, and metabolic support. Cerebrospinal fluid diversion strategies varied both across centers and within centers, with roughly equal proportion of centers adopting a strategy of continuous cerebrospinal fluid diversion and a strategy of no cerebrospinal fluid diversion. Use of mannitol and hypertonic saline for hyperosmolar therapies was widespread among centers (90.1% and 96.9%, respectively). Of centers using hypertonic saline, 3% saline preparations were the most common but many other concentrations were in common use. Routine hyperventilation was not reported as a standard goal and 31.3% of centers currently use Pbo2 monitoring for cerebral hypoxia. The time to start nutritional support and glucose administration varied widely, with nutritional support beginning before 96 hours and glucose administration being started earlier in most centers.
There were marked differences in medical goals for children with severe traumatic brain injury across our international consortium, and these differences seemed to be greatest in areas with the weakest evidence in the literature. Future studies that determine the superiority of the various medical therapies outlined within our survey would be a significant advance for the pediatric neurotrauma field and may lead to new standards of care and improved study designs for clinical trials.
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