Department of Neurological Surgery, Stony Brook University Renaissance School of Medicine, Health Science Center T12, Room 080, 100 Nicolls Rd, Stony Brook, NY, 11790, USA.
Department of Emergency Medicine, Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA.
Childs Nerv Syst. 2022 Jan;38(1):51-62. doi: 10.1007/s00381-021-05364-9. Epub 2021 Sep 23.
Traumatic brain injury (TBI) disproportionately affects children within low- and middle-income countries (LMICs). Prehospital emergency care can mitigate secondary brain injury and improve outcomes. Here, we systematically review clinical practice guidelines (CPGs) for pediatric TBI with the goal to inform LMICs prehospital care.
A systematic search was conducted in PubMed/Medline, Embase, and Web of Science databases. We appraised evidence-based CPGs addressing prehospital management of pediatric TBI using the Appraisal of Guidelines for Research & Evaluation (AGREE) tool. CPGs were rated as high-quality if ≥ 5 (out of 6) AGREE domains scored > 60%.
Of the 326 articles identified, 10 CPGs were included in analysis. All 10 were developed in HICs, and 4 were rated as high-quality. A total of 154 pediatric prehospital recommendations were grouped into three subcategories, initial assessment (35.7%), prehospital treatment (38.3%), and triage (26.0%). Of these, 79 (51.3%) were evidence-based with grading, and 31 (20.1%) were consensus-based without direct evidence.
Currently available CPGs for prehospital pediatric TBI management were all developed in HICs. Four CPGs have high-quality, and recommendations from these can serve as frameworks for LMICs or resource-limited settings. Context-specific evaluation and implementation of evidence-based recommendations allow LMIC settings to respond to the public health crisis of pediatric TBI and address gaps in trauma care systems.
创伤性脑损伤（TBI）在中低收入国家（LMICs）中对儿童的影响不成比例。院前急救可以减轻继发性脑损伤并改善预后。在这里，我们系统地回顾了小儿 TBI 的临床实践指南（CPGs），旨在为 LMICs 的院前护理提供信息。
在 PubMed/Medline、Embase 和 Web of Science 数据库中进行了系统搜索。我们使用评估研究和评估指南（AGREE）工具评估了针对小儿 TBI 院前管理的循证 CPG。如果≥5（6 个中的 6 个）AGREE 领域得分>60%，则将 CPG 评为高质量。
在 326 篇文章中，有 10 篇 CPG 被纳入分析。所有 10 篇 CPG 均在高收入国家制定，其中 4 篇被评为高质量。总共提出了 154 项小儿院前建议，分为三个亚组，初始评估（35.7%）、院前治疗（38.3%）和分诊（26.0%）。其中，79 项（51.3%）是基于证据的分级，31 项（20.1%）是基于共识的，没有直接证据。
目前可用于小儿 TBI 院前管理的 CPG 均在高收入国家制定。其中 4 项 CPG 具有高质量，这些建议可以作为 LMIC 或资源有限的环境的框架。基于具体情况评估和实施基于证据的建议，使 LMIC 环境能够应对小儿 TBI 的公共卫生危机，并解决创伤护理系统中的差距。
