Download PDF
J Pediatr Intensive Care
DOI: 10.1055/s-0042-1744298
Original Article

Severe Traumatic Brain Injury in French-Speaking Pediatric Intensive Care Units: Study of Practices

Manon Denis 
1   Pediatric Intensive Care Unit, CHU de Caen, Caen, France
2   Pediatric Intensive Care Unit, CHU de Nantes, Nantes, France
3   Institut du thorax, INSERM, CNRS, Nantes Université, CHU de Nantes, France
4   Institut du thorax, INSERM, CNRS, Nantes Université, France
,
Benjamin Lauzier
4   Institut du thorax, INSERM, CNRS, Nantes Université, France
,
Nadia Roumeliotis
5   Pediatric Intensive Care Unit, CHU Sainte Justine, Montréal, Quebec, Canada
6   Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
,
Gilles Orliaguet
7   Surgical Pediatric Intensive Care Unit, Necker–Enfants Malades University Hospital, Paris, France
8   Department of Pediatric and Obstetrical Anaesthesia and Intensive Care, Necker–Enfants Malades University Hospital, GHU AP-HP Centre - Université de Paris, Paris, France
9   EA08 Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Université de Paris, Paris, France
,
Guillaumes Emeriaud
5   Pediatric Intensive Care Unit, CHU Sainte Justine, Montréal, Quebec, Canada
6   Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
,
Etienne Javouhey
10   Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
,
David Brossier
1   Pediatric Intensive Care Unit, CHU de Caen, Caen, France
6   Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
11   School of Medicine, University Caen Normandie, Caen, F-14000, France
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Best strategies for managing severe pediatric traumatic brain injury (TBI) are not established, with wide variations among professional practices. The main objective of this study was to assess compliance with updated pediatric TBI management guidelines (2019). A survey was distributed among French-speaking pediatric intensive care physicians from April 1 to June 30, 2019. The survey was based on a clinical case with a total of 70 questions that cover the 15 items of the 2019 TBI guidelines. The questions evaluated the assessment and management of TBI during the acute and intensive care phases. Of 487 e-mails sent, 78 surveys were included. Guidelines were adhered to (> 60%) for 10 of 15 items in the guidelines. Strong adherence to recent guideline changes was achieved for seizure prophylaxis with levetiracetam (n = 21/33, 64%) and partial pressure of carbon dioxide threshold (n = 52, 67%). However, management of the sodium and glucose thresholds and the role of transcranial Doppler were not consistent with the guidelines. Assessment of brain tissue oxygenation (n = 12, 16%) and autoregulation (n = 35, 45%) was not a common practice. There was strong agreement among clinicians on the intracranial pressure (> 80%) and cerebral perfusion pressure (> 70%) thresholds used according to age. Overall, stated practices for the management of TBI appear to be relatively standardized among responders. Variations persist in areas with a lack of evidence and pediatric-specific recommendations.

Keywords

traumatic brain injury - pediatric intensive care - guidelines - survey - intracranial hypertension

Authors' Contributions

M.D. performed the survey, the data collection and analysis, drafted the initial manuscript, and reviewed and revised the manuscript. B.M. contributed to perform online questionnaire, analyze the data, and reviewed and revised the manuscript. G.O., E.J., and G.E. reviewed and revised the survey and the manuscript. N.R. reviewed and revised the manuscript and, as English speaker, performed English editing. D.B. contributed to the conception of the survey, the manuscript and the interpretation of the data, coordinated and supervised the data analysis, drafted the initial manuscript, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


Supplementary Material



Publication History

Received: 15 December 2021

Accepted: 10 February 2022

Article published online:
08 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Patteau G, Chéron G. Traumatisme crânien chez l'enfant. Reanimation 2014; 23 (05) 507-516
    CrossrefPubMedGoogle Scholar
  • 2 Orliaguet G, Trabold F. Particularités du Traumatisme Crânien Chez L'enfant. Mapar. 2005: 475-483
    Google Scholar
  • 3 Allen KA. Pathophysiology and treatment of severe traumatic brain injuries in children. J Neurosci Nurs 2016; 48 (01) 15-27 , quiz E1
    CrossrefPubMedGoogle Scholar
  • 4 Javouhey E, Guérin AC, Chiron M, Floret D. [Epidemiology and prevention of head trauma in children]. Arch Pediatr 2006; 13 (06) 528-530
    CrossrefPubMedGoogle Scholar
  • 5 Levin HS, Aldrich EF, Saydjari C. et al. Severe head injury in children: experience of the Traumatic Coma Data Bank. Neurosurgery 1992; 31 (03) 435-443 , discussion 443–444
    CrossrefPubMedGoogle Scholar
  • 6 Dewan MC, Mummareddy N, Wellons III JC, Bonfield CM. Epidemiology of global pediatric traumatic brain injury: qualitative review. World Neurosurg 2016; 91: 497-509.e1
    CrossrefPubMedGoogle Scholar
  • 7 Vuillaume C, Mrozek S, Fourcade O, Geeraerts T. How can we determine the best cerebral perfusion pressure in pediatric traumatic brain injury?. Ann Fr Anesth Reanim 2013; 32 (12) e225-e229
    CrossrefPubMedGoogle Scholar
  • 8 Lovett ME, O'Brien NF, Leonard JR. Children with severe traumatic brain injury, intracranial pressure, cerebral perfusion pressure, what does it mean? A review of the literature. Pediatr Neurol 2019; 94: 3-20
    CrossrefPubMedGoogle Scholar
  • 9 Güiza F, Depreitere B, Piper I. et al. Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury. Intensive Care Med 2015; 41 (06) 1067-1076
    CrossrefPubMedGoogle Scholar
  • 10 Marescal C, Adnet P, Bello N, Halle I, Forget AP, Boittiaux P. Agressions cérébrales secondaires d'origine systémique chez les enfants traumatisés craniocérébraux graves. Ann Fr Anesth Reanim 1998; 17 (03) 234-239
    CrossrefPubMedGoogle Scholar
  • 11 Kochanek PM, Carney N, Adelson PD. et al; American Academy of Pediatrics-Section on Neurological Surgery, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Child Neurology Society, European Society of Pediatric and Neonatal Intensive Care, Neurocritical Care Society, Pediatric Neurocritical Care Research Group, Society of Critical Care Medicine, Paediatric Intensive Care Society UK, Society for Neuroscience in Anesthesiology and Critical Care, World Federation of Pediatric Intensive and Critical Care Societies. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents–second edition. Pediatr Crit Care Med 2012; 13 (Suppl. 01) S1-S82
    CrossrefPubMedGoogle Scholar
  • 12 Kochanek PM, Tasker RC, Carney N. et al. Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, third edition: update of the Brain Trauma Foundation Guidelines. Pediatr Crit Care Med 2019; 20 (3S, suppl 1): S1-S82
    CrossrefPubMedGoogle Scholar
  • 13 Adelson PD, Bratton SL, Carney NA. et al; American Association for Surgery of Trauma, Child Neurology Society, International Society for Pediatric Neurosurgery, International Trauma Anesthesia and Critical Care Society, Society of Critical Care Medicine, World Federation of Pediatric Intensive and Critical Care Societies. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 1: introduction. Pediatr Crit Care Med 2003; 4 (Suppl 3): S2-S4
    CrossrefPubMedGoogle Scholar
  • 14 Kochanek PM, Tasker RC, Bell MJ. et al. Management of pediatric severe traumatic brain injury: 2019 consensus and guidelines-based algorithm for first and second tier therapies. Pediatr Crit Care Med 2019; 20 (03) 269-279
    CrossrefPubMedGoogle Scholar
  • 15 Vavilala MS, Kernic MA, Wang J. et al; Pediatric Guideline Adherence and Outcomes Study. Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury. Crit Care Med 2014; 42 (10) 2258-2266
    CrossrefPubMedGoogle Scholar
  • 16 Bell MJ, Adelson PD, Hutchison JS. et al; Multiple Medical Therapies for Pediatric Traumatic Brain Injury Workgroup. Differences in medical therapy goals for children with severe traumatic brain injury-an international study. Pediatr Crit Care Med 2013; 14 (08) 811-818
    CrossrefPubMedGoogle Scholar
  • 17 Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ. Brain Trauma Foundation. Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med 2002; 30 (08) 1870-1876
    CrossrefPubMedGoogle Scholar
  • 18 Dean NP, Boslaugh S, Adelson PD, Pineda JA, Leonard JR. Physician agreement with evidence-based recommendations for the treatment of severe traumatic brain injury in children. J Neurosurg 2007; 107 (Suppl 5): 387-391
    PubMedGoogle Scholar
  • 19 Brolliar SM, Moore M, Thompson HJ. et al. A qualitative study exploring factors associated with provider adherence to severe pediatric traumatic brain injury guidelines. J Neurotrauma 2016; 33 (16) 1554-1560
    CrossrefPubMedGoogle Scholar
  • 20 Huijben JA, Volovici V, Cnossen MC. et al; CENTER-TBI investigators and participants. Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Crit Care 2018; 22 (01) 90
    CrossrefPubMedGoogle Scholar
  • 21 Vavilala MS, King MA, Yang JT. et al. The Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in severe traumatic brain injury: a single-centre hybrid implementation and effectiveness study. Lancet Child Adolesc Health 2019; 3 (01) 23-34
    CrossrefPubMedGoogle Scholar
  • 22 Geeraerts T, Velly L, Abdennour L. et al; French Society of Anaesthesia, Intensive Care Medicine, in partnership with Association de neuro-anesthésie-réanimation de langue française (Anarlf), French Society of Emergency Medicine (Société Française de Médecine d'urgence (SFMU), Société française de neurochirurgie (SFN), Groupe francophone de réanimation et d'urgences pédiatriques (GFRUP), Association des anesthésistes-réanimateurs pédiatriques d'expression française (Adarpef). Management of severe traumatic brain injury (first 24 hours). Anaesth Crit Care Pain Med 2018; 37 (02) 171-186
    CrossrefPubMedGoogle Scholar
  • 23 Carney N, Totten AM, O'Reilly C. et al. Guidelines for the Management of Severe Traumatic Brain Injury, fourth edition. Neurosurgery 2017; 80 (01) 6-15
    CrossrefPubMedGoogle Scholar
  • 24 Chambers IR, Jones PA, Lo TYM. et al. Critical thresholds of intracranial pressure and cerebral perfusion pressure related to age in paediatric head injury. J Neurol Neurosurg Psychiatry 2006; 77 (02) 234-240
    CrossrefPubMedGoogle Scholar
  • 25 Allen BB, Chiu Y-L, Gerber LM, Ghajar J, Greenfield JP. Age-specific cerebral perfusion pressure thresholds and survival in children and adolescents with severe traumatic brain injury. Pediatr Crit Care Med 2014; 15 (01) 62-70
    CrossrefPubMedGoogle Scholar
  • 26 Figaji AA, Zwane E, Fieggen AG, Siesjo P, Peter JC. Transcranial Doppler pulsatility index is not a reliable indicator of intracranial pressure in children with severe traumatic brain injury. Surg Neurol 2009; 72 (04) 389-394
    CrossrefPubMedGoogle Scholar
  • 27 Lazaridis C, Smielewski P, Menon DK, Hutchinson P, Pickard JD, Czosnyka M. Patient-specific thresholds and doses of intracranial hypertension in severe traumatic brain injury. Acta Neurochir Suppl (Wien) 2016; 122: 117-120
    CrossrefPubMedGoogle Scholar
  • 28 Lazaridis C, DeSantis SM, Smielewski P. et al. Patient-specific thresholds of intracranial pressure in severe traumatic brain injury. J Neurosurg 2014; 120 (04) 893-900
    CrossrefPubMedGoogle Scholar
  • 29 Nagel C, Diedler J, Gerbig I, Heimberg E, Schuhmann MU, Hockel K. State of cerebrovascular autoregulation correlates with outcome in severe infant/pediatric traumatic brain injury. Acta Neurochir Suppl (Wien) 2016; 122: 239-244
    CrossrefPubMedGoogle Scholar
  • 30 Brady KM, Shaffner DH, Lee JK. et al. Continuous monitoring of cerebrovascular pressure reactivity after traumatic brain injury in children. Pediatrics 2009; 124 (06) e1205-e1212
    CrossrefPubMedGoogle Scholar
  • 31 Lewis PM, Czosnyka M, Carter BG. et al. Cerebrovascular pressure reactivity in children with traumatic brain injury. Pediatr Crit Care Med 2015; 16 (08) 739-749
    CrossrefPubMedGoogle Scholar
  • 32 Young AMH, Donnelly J, Czosnyka M. et al. Continuous multimodality monitoring in children after traumatic brain injury-preliminary experience. PLoS One 2016; 11 (03) e0148817
    CrossrefPubMedGoogle Scholar
  • 33 Hockel K, Diedler J, Neunhoeffer F, Heimberg E, Nagel C, Schuhmann MU. Time spent with impaired autoregulation is linked with outcome in severe infant/paediatric traumatic brain injury. Acta Neurochir (Wien) 2017; 159 (11) 2053-2061
    CrossrefPubMedGoogle Scholar
  • 34 Güiza F, Meyfroidt G, Lo TYM, Jones PA, Van den Berghe G, Depreitere B. Continuous optimal CPP based on minute-by-minute monitoring data: a study of a pediatric population. Acta Neurochir Suppl (Wien) 2016; 122: 187-191
    CrossrefPubMedGoogle Scholar