Previous studies have shown variations in management routines for children with traumatic brain injury (TBI) in Sweden. It is unknown if this management has changed after the publication of the Scandinavian Neurotrauma Committee guidelines in 2016 (SNC16). Also, knowledge of current practice routines may guide development of an efficient implementation strategy for the guidelines. The aim of this study is therefore to describe current management routines in paediatric TBI on a hospital/organizational level in Sweden. Secondary aims are to analyse differences in management over time, to assess the current dissemination status of the SNC16 guideline and to analyse possible variations between hospitals. This is a sequential, cross-sectional, structured survey in five sections, covering initial management routines for paediatric TBI in Sweden. Respondents, with profound knowledge of local management routines and recommendations, were identified for all Swedish hospitals with an emergency department managing children (age 0–17 year) via phone/mail before distribution of the survey. Responses were collected via an on-line survey system during June 2020–March 2021. Data are presented as descriptive statistics and comparisons were made using Fisher exact test, when applicable. 71 of the 76 identified hospitals managed patients with TBI of all ages and 66 responded (response rate 93%). 56 of these managed children and were selected for further analysis. 76% (42/55) of hospitals have an established guideline to aid in clinical decision making. Children with TBI are predominately managed by inexperienced doctors (84%; 47/56), primarily from non-paediatric specialities (75%; 42/56). Most hospitals (75%; 42/56) have the possibility to admit and observe children with TBI of varying degrees and almost all centres have complete access to neuroradiology (96%; 54/56). In larger hospitals, it was more common for nurses to discharge patients without doctor assessment when compared to smaller hospitals (6/9 vs. 9/47; p < 0.001). Presence of established guidelines (14/51 vs. 42/55; p < 0.001) and written observation routines (16/51 vs. 29/42; p < 0.001) in hospitals have increased significantly since 2006. TBI management routines for children in Sweden still vary, with some differences occurring over time. Use of established guidelines, written observation routines and information for patients/guardians have all improved. These results form a baseline for current management and may also aid in guideline implementation.

中文翻译：

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瑞典小儿创伤性脑损伤的管理：一项全国性横断面调查

先前的研究表明，瑞典创伤性脑损伤 (TBI) 儿童的管理程序存在差异。2016 年斯堪的纳维亚神经创伤委员会指南 (SNC16) 发布后，这种管理方式是否发生变化尚不清楚。此外，对当前实践程序的了解可以指导制定有效的指南实施策略。因此，本研究的目的是描述瑞典医院/组织级别的儿科 TBI 的当前管理程序。次要目标是分析不同时间的管理差异，评估 SNC16 指南的当前传播状态，并分析医院之间可能存在的差异。这是一项连续的、横断面的、结构化的调查，分为五个部分，涵盖瑞典儿科 TBI 的初始管理程序。在分发调查之前，通过电话/邮件为所有设有急诊科管理儿童（0-17 岁）的瑞典医院确定了对当地管理程序和建议有深入了解的受访者。答复是在 2020 年 6 月至 2021 年 3 月期间通过在线调查系统收集的。数据以描述性统计数据的形式呈现，并在适用时使用 Fisher 精确检验进行比较。在确定的 76 家医院中，有 71 家管理了所有年龄的 TBI 患者，66 家做出了回应（回应率 93%）。其中 56 名被管理的儿童被选中进行进一步分析。76% (42/55) 的医院有既定的指导方针来帮助临床决策。患有 TBI 的儿童主要由经验不足的医生管理 (84%; 47/56)，主要来自非儿科专业 (75%; 42/56)。大多数医院 (75%; 42/56) 有可能收治和观察不同程度的 TBI 儿童，几乎所有中心都可以使用神经放射学 (96%; 54/56)。与较小的医院相比，在较大的医院中，护士在没有医生评估的情况下出院的情况更为常见（6/9 对 9/47；p < 0.001）。自 2006 年以来，医院制定的指南（14/51 对 42/55；p < 0.001）和书面观察程序（16/51 对 29/42；p < 0.001）显着增加。瑞典仍然各不相同，随着时间的推移会出现一些差异。既定指南、书面观察程序和患者/监护人信息的使用都得到了改善。这些结果构成了当前管理的基线，也可能有助于指南的实施。