Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham, United Kingdom.
Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
Pediatr Crit Care Med. 2021 Apr 1;22(4):e270-e274. doi: 10.1097/PCC.0000000000002574.
Traumatic brain injury in children is a leading cause of morbidity and mortality. Lack of high-quality evidence may lead to variation in management within and between PICUs. We examined U.K. pediatric traumatic brain injury management guidelines for extent of variability.
Analysis of U.K. PICU traumatic brain injury guidelines for areas of consistency and variation among each other and against the second edition of Brain Trauma Foundation pediatric traumatic brain injury guidelines.
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Textual analysis of U.K. PICU guidelines.
Twelve key clinical topics in three traumatic brain injury management domains were identified. We performed textual analysis of recommendations from anonymized local guidelines and compared them against each other and the Brain Trauma Foundation pediatric traumatic brain injury guidelines. Fifteen guidelines used by 16 of the 20 U.K. PICUs that manage traumatic brain injury were analyzed. Relatively better consistency was observed for intracranial pressure treatment thresholds (10/15), avoiding prophylactic hyperventilation (15/15), cerebrospinal fluid drainage (13/15), barbiturate (14/15), and decompressive craniectomy (12/15) for intracranial hypertension. There was less consistency in indications for intracranial pressure monitoring (3/15), cerebral perfusion pressure targets (2/15), target osmolarities (7/15), and hyperventilation for intracranial hypertension (2/15). Variability in choice and hierarchy of the interventions for intracranial hypertension were observed, albeit with some points of consistency.
Significant variability in pediatric traumatic brain injury management guidelines exists. Despite the heterogeneity, we have highlighted a few points of consistency within the key topic areas of pediatric traumatic brain injury management. We anticipate that this provides impetus for further work around standardization.
儿童创伤性脑损伤是发病率和死亡率的主要原因。缺乏高质量的证据可能导致 PICUs 内部和之间的管理方法存在差异。我们检查了英国儿科创伤性脑损伤管理指南，以了解其变异性的程度。
分析英国 PICU 创伤性脑损伤指南，以了解彼此之间以及与脑损伤基金会小儿创伤性脑损伤指南第二版之间的一致性和变异性。
不适用。
不适用。
对英国 PICU 指南进行文本分析。
确定了三个创伤性脑损伤管理领域中的 12 个关键临床主题。我们对匿名的地方指南中的建议进行了文本分析，并将其相互比较，以及与脑损伤基金会小儿创伤性脑损伤指南进行比较。分析了英国 20 家管理创伤性脑损伤的 PICUs 中的 16 家使用的 15 条指南。颅内压治疗阈值（10/15）、避免预防性过度通气（15/15）、脑脊液引流（13/15）、巴比妥类药物（14/15）和颅内压升高时的减压性颅骨切除术（12/15）方面的一致性较好。颅内压监测的适应症（3/15）、脑灌注压目标（2/15）、目标渗透压（7/15）和颅内压升高时的过度通气（2/15）方面的一致性较差。尽管存在异质性，但我们观察到颅内压升高干预措施的选择和层次存在一定的变异性。
小儿创伤性脑损伤管理指南存在显著的变异性。尽管存在异质性，但我们在小儿创伤性脑损伤管理的关键主题领域内强调了一些一致性。我们预计这将为进一步的标准化工作提供动力。
