What is the appropriate course of action for obtaining consent for a child with a subdural hemorrhage (Subdural Hemorrhage, SDH) requiring immediate surgical intervention in the Operating Room (OR)?

From the Guidelines

In this emergency scenario of a child with subdural hemorrhage requiring immediate surgical intervention, the correct approach is option B - take consent from the nearest relative present. When a child needs urgent surgery for a life-threatening condition like subdural hemorrhage and the father is only available by phone, verbal consent over the phone is not ideal due to documentation challenges and inability to verify identity, as suggested by the guidelines for obtaining valid consent for gastrointestinal endoscopy procedures 1. The nearest available relative who has legal authority (such as the mother, grandparent, or legal guardian physically present) should provide written informed consent. This approach balances the urgent medical need with proper consent requirements.

Some key considerations in the management of such cases include:

• The need for urgent neurosurgical consultation and intervention after control of life-threatening hemorrhage is established, as emphasized in the WSES consensus conference guidelines for monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours 1.
• The importance of safe transfer of the brain-injured patient, with guidelines suggesting that for conditions like acute subdural hematoma with mass effect, a time-critical transfer from the referring hospital by the local team is appropriate 1.
• Ensuring that the transfer is conducted with appropriate care to prevent further injury, including maintaining stable haemodynamics and avoiding actions that could exacerbate intracranial pressure, as discussed in the guidelines for safe transfer of the brain-injured patient: trauma and stroke, 2019 1.

If no appropriate relative is available and the surgery is truly emergent to prevent death or serious disability, you may proceed under the principle of implied consent for emergency treatment, documenting thoroughly your attempts to obtain consent and the medical necessity. Colleague consent (option C) is never appropriate as colleagues have no legal authority to consent for the patient. After the emergency is addressed, proper consent should be obtained from the legal guardians as soon as possible.

From the Research

Emergency Situation

In a scenario where a child with subdural hematoma (Hge) needs to enter the operating room (OR) urgently, the priority is to ensure the child receives immediate medical attention.

Consent for Emergency Treatment

• The most appropriate action would be to take consent from the nearest relative [B], as this ensures that someone with the authority to make medical decisions for the child is involved in the process.
• This approach aligns with standard medical practice in emergency situations where time is of the essence, and the child's life or well-being is at risk.
• While taking consent from the father by phone [A] could be considered if the nearest relative is not available, it may not always be feasible or immediate enough in an emergency setting.
• Taking consent from colleagues [C] is not appropriate, as they do not have the legal authority to make medical decisions for the patient.

Medical Management and Surgical Intervention

• Studies such as 2 and 3 emphasize the importance of rapid and appropriate management of subdural hematomas, including surgical intervention when necessary, to prevent further brain damage and improve outcomes.
• The management of subdural hematoma involves a multidisciplinary approach, including neurosurgical intervention, intensive care, and medical management to control intracranial pressure, prevent seizures, and maintain optimal cerebral perfusion [(2,3)].
• Specific considerations for infants, as discussed in 4, highlight the need for specialized care, including early blood transfusion, careful surgical techniques, and postoperative management that addresses unique pathophysiological aspects such as status epilepticus and hyperperfusion injury.

Conclusion Not Applicable

As per the guidelines, no conclusion section should be provided. The information above directly addresses the scenario and the actions to be taken based on the available evidence [(2,3,4,5,6)].