Citation

Ben Abdeljelil A, Freire GC, Yanchar N, Turgeon AF, Beno S, Bérubé M, Stang A, Stelfox HT, Zemek R, Beaulieu E, Gagnon I, Gabbe B, Lauzier F, Labrosse M, Tardif PA, Deshommes T, Gnanvi J, Moore L. J. Neurotrauma 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2023.0149

PMID

37341019

Abstract

Traumatic brain injury (TBI) is the leading cause of death and disability in children. Many clinical practice guidelines (CPGs) have addressed pediatric TBI in the last decade but significant variability in the use of these guidelines persists. Here, we systematically review CPGs recommendations for pediatric moderate-to-severe TBI, evaluate the quality of CPGs, synthesize the quality of evidence and strength of included recommendations, and identify knowledge gaps. A systematic search was conducted in Medline, Embase, Cochrane CENTRAL, Web of Science and websites of organisations publishing recommendations on pediatric injury care. We included CPGs developed in high-income countries from January 2012 to May 2023, with at least one recommendation targeting pediatric (≤ 19 years old) moderate-to-severe TBI populations. The quality of included clinical practice guidelines was assessed using the AGREE II tool. We synthesized evidence on recommendations using a matrix based on the GRADE framework. We identified 15 CPGs of which nine were rated moderate to high quality using AGREE II. We identified 90 recommendations, of which 40 (45%) were evidence-based. Eleven of these were based on moderate to high quality evidence and were graded as moderate or strong by at least one guideline. These included transfer, imaging, intracranial pressure control, and discharge advice. We identified gaps in evidence-based recommendations for red blood cell transfusion, plasma and platelet transfusion, thromboprophylaxis, surgical antimicrobial prophylaxis, early diagnosis of hypopituitarism, and mental health mangement. Many up-to-date CPGs are available, but there is a paucity of evidence to support recommendations, highlighting the urgent need for robust clinical research in this vulnerable population. Our results may be used by clinicians to identify recommendations based on the highest level of evidence, by healthcare administrators to inform guideline implementation in clinical settings, by researchers to identify areas where robust evidence is needed, and by guideline writing groups to inform the update of existing guidelines or the development of new ones.

Language: en

Keywords

PEDIATRIC BRAIN INJURY; GUIDELINES; TRAUMATIC BRAIN INJURY