From the Guidelines
Pediatric patients with Traumatic Brain Injury (TBI) should be managed in a pediatric trauma centre or in an adult trauma centre with pediatric expertise to reduce morbidity and mortality. The management of severe TBI in children is crucial, and recent studies have emphasized the importance of targeted temperature management, intracranial pressure monitoring, and early rehabilitation interventions.
Key Considerations
- Managing severe TBI children in a pediatric trauma centre or in an adult trauma centre with pediatric expertise is associated with reduced morbidity and mortality 1.
- Targeted temperature control is a complex intervention that aims to control body or brain temperature to prevent further brain injury and improve neurological outcome, with recent consensus recommendations emphasizing its importance in severe TBI management 1.
- Intracranial pressure monitoring is less performed in children < 2 years old, but it is crucial in managing severe TBI, as it helps in maintaining cerebral perfusion pressure and preventing secondary brain injury 1.
Recent Studies
- A recent study published in 2024 provides best-practice consensus recommendations for the real-world application of targeted temperature control in severe TBI with ICP guided treatments 1.
- The importance of early rehabilitation interventions in pediatric TBI management cannot be overstated, as it significantly improves functional outcomes and reduces long-term disability.
Recommendations
- Pediatric TBI patients should be managed in a specialized trauma centre with pediatric expertise to ensure optimal care and reduce morbidity and mortality.
- Targeted temperature management and intracranial pressure monitoring should be used in conjunction with early rehabilitation interventions to improve outcomes in pediatric TBI patients.
- Further research is needed to determine the optimal temperature targets and duration of targeted temperature control in severe TBI, as well as the role of other interventions such as hyperosmolar therapy and decompressive craniectomy.
From the Research
Recent Studies on TBI Management in Pediatric Patients
- The management of traumatic brain injury (TBI) in pediatric patients has been the subject of several recent studies, including a 2023 article on rehabilitation care 2 and a 2023 update on pediatric TBI 3.
- These studies highlight the importance of early and longitudinal involvement of rehabilitation experts in managing complications and optimizing outcomes for children with TBI 2.
- Recent literature has also provided new insights into the burden of pediatric TBI and patient outcomes across geographical divides and the severity spectrum 3.
- Advanced MRI sequences are being used to better understand pathology and improve prognostication, and there is growing interest in non-invasive monitoring 3.
Management Guidelines and Algorithms
- A 2019 consensus and guidelines-based algorithm for first and second tier therapies in the management of pediatric severe TBI has been developed 4.
- This algorithm focuses on preventing and/or treating intracranial hypertension, optimizing cerebral perfusion pressure, and optimizing partial pressure of brain tissue oxygen.
- A 2025 evidence-based approach to the management of severe TBI in pediatric patients has also been published, providing 14 evidence-based recommendations covering nine topics, including imaging studies, neuromonitoring, and decompressive craniectomy 5.
Key Findings and Recommendations
- Recent studies emphasize the importance of individualized therapeutic goals and the use of intensive neuromonitoring to guide treatment selection 6.
- The use of hyperosmolar therapies and cerebrospinal fluid drainage in severe pediatric TBI has been advanced by the first large-scale comparative effectiveness trial 3.
- The growth of large and global networks is a welcome development that addresses the limitations of small sample size and generalizability typical of single-center studies 3.