Abstract
Acute medical management of traumatic brain injury (TBI) can be challenging outside of the resuscitation bay, specifically while obtaining a computed tomography (CT) scan of the brain. We sought out to determine the management practices of Canadian traumatologists for pediatric patients with severe TBI requiring CT in the emergency department (ED). In 2019, surveys were sent to trauma directors in hospitals across Canada to ascertain their clinical practices. Team members present in the CT scan included physicians (89%), registered nurses (100%), and respiratory therapists (38%). The average time to and from the CT scanner was one hour. Over half of respondents (56%) had experienced an adverse event in CT with variable access (11–56%) to necessary resuscitation equipment and medications. Significant hypotension (44%) was the most common adverse event experienced. With the exception of an end tidal CO2 monitoring (56%), heart rate, rhythm, respiratory rate, saturation, and blood pressure were always monitored during a CT scan. Head of bed elevation had an approximately equal distribution of flat (44%) versus elevated (56%). The practice variability of Canadian traumatologists may reflect a lack of evidence to guide patient management. Future research and knowledge translation efforts are needed to optimize patient care during neuroimaging.
Similar content being viewed by others
References
Alkhoury, F., & Kyriakides, T. C. (2014). Intracranial pressure monitoring in children with severe traumatic brain injury: National Trauma Data Bank-based review of outcomes. JAMA Surgery, 149(6), 544–548.
Arabi, Y. M., Haddad, S., Tamim, H. M., Al-Dawood, A., Al-Qahtani, S., Ferayan, A., Al-Abdulmughni, I., & Rugaan, A. (2010). Mortality reduction after implementing a clinical practice guidelines–based management protocol for severe traumatic brain injury. Journal of Critical Care, 25(2), 190–195.
Bennett, T. D., Statler, K. D., Korgenski, E. K., & Bratton, S. L. (2012). Osmolar therapy in pediatric traumatic brain injury. Critical Care Medicine, 40(1), 208–215.
Burns, K. E., Duffett, M., Kho, M. E., Meade, M. O., Adhikari, N. K., Sinuff, T., & ACCEDEMY Group. (2008). A guide for the design and conduct of self-administered surveys of clinicians. CMAJ, 179(3), 245–252.
Centers for Disease Control and Prevention. (2019). Surveillance report of traumatic brain injury-related emergency department visits, hospitalizations, and deaths – United States, 2014. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Retrieved March 2, 2020, from https://www.cdc.gov/traumaticbraininjury/get_the_facts.html
Cnossen, M. C., Scholten, A. C., Lingsma, H. F., Synnot, A., Tavender, E., Ganter, D., & Polinder, S. (2016). Adherence to guidelines in adult patients with traumatic brain injury: A living systematic review. Journal of Neurotrauma. https://doi.org/10.1089/neu.2015.4121.
Fan, J. Y. (2004). Effect of backrest position on intracranial pressure and cerebral perfusion pressure in individuals with brain injury: A systematic review. The Journal of Neuroscience Nursing, 36(5), 278–288.
Hansen, G., McDonald, P. J., Martin, D., & Vallance, J. K. (2018). Pre-trauma center management of intracranial pressure in severe pediatric traumatic brain injury. Pediatric Emergency Care, 34(5), 330–333.
Hansen, G., & Vallance, J. K. (2015). Ventilation monitoring for severe pediatric traumatic brain injury during interfacility transport. International Journal of Emergency Medicine, 8(1), 41.
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381.
Jagannathan, J., Okonkwo, D. O., Yeoh, H. K., Dumont, A. S., Saulle, D., Haizlip, J., Barth, J. T., Jane, J. A., & Jane Jr., J. A. (2008). Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intracranial pressure. Journal of Neurosurgery. Pediatrics, 2(4), 240–249.
Khormi, Y. H., Gosadi, I., Campbell, S., Senthilselvan, A., O'Kelly, C., & Zygun, D. (2018). Adherence to brain Trauma Foundation guidelines for Management of Traumatic Brain Injury Patients and its Effect on outcomes: Systematic review. Journal of Neurotrauma, 35(13), 1407–1418.
Kochanek, P. M., Tasker, R. C., Carney, N., Totten, A. M., et al. (2019). Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, third edition: Update of the brain Trauma Foundation guidelines. Pediatr Crit Care Med, 20(3S Suppl 1), S1-S82.
Martin, M., Cook, F., Lobo, D., Vermersch, C., Attias, A., Ait-Mamar, B., et al. (2017). Secondary insults and adverse events during intrahospital transport of severe traumatic brain-injured patients. Neurocritical Care, 26(1), 87–95.
O’Lynnger, T. M., Shannon, C. N., Le, T. M., Greeno, A., Chung, D., Lamb, F. S., & Wellons, J. C. (2016). Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge. Journal of Neurosurgery. Pediatrics, 17(1), 19–26.
Palmer, S., Bader, M. K., Qureshi, A., Palmer, J., Shaver, T., Borzatta, M., & Stalcup, C. (2001). The impact on outcomes in a community hospital setting of using the AANS traumatic brain injury guidelines. Americans associations for neurologic surgeons. The Journal of Trauma, 50(4), 657–664.
Public Health Agency of Canada, Government of Canada. Sport and Recreation-related Traumatic Brain Injuries among Canadian Children and Youth. Government of Canada, 2018. Retrieved on Februrary 27, 2020, from https://www.canada.ca/en/public-health/services/diseases/concussion-sign-symptoms/concussion-sport-infographic.html.
Talving, P., Karamanos, E., Teixeira, P. G., Skiada, D., Lam, L., Belzberg, H., Inaba, K., & Demetriades, D. (2013). Intracranial pressure monitoring in severe head injury: Compliance with brain Trauma Foundation guidelines and effect on outcomes: A prospective study. Journal of Neurosurgery, 119(5), 1248–1254.
Tasker, R. C. (2012). Intracranial pressure: Influence of head-of-bed elevation and beyond. Pediatric Critical Care Medicine, 13(1), 116–117.
Taylor, C. A., Bell, J. M., Breiding, M. J., & Xu, L. (2017). Traumatic brain injury–related emergency department visits, hospitalizations, and deaths — United States, 2007 and 2013. MMWR Surveillance Summaries, 66(9), 1–16.
Tilford, J. M., Aitken, M. E., Anand, K. J., Green, J. W., Goodman, A. C., Parker, J. G., & Adelson, P. D. (2005). Hospitalizations for critically ill children with traumatic brain injuries: A longitudinal analysis. Critical Care Medicine, 33(9), 2074–2081.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
On behalf of all authors, there were no real or perceived conflicts of interest noted.
Ethical Standards and Informed Consent
Authorization to conduct this study was granted by the University of Saskatchewan and Saskatchewan Health Authority (Bio-REB 1043). Consent was obtained from all survey respondents.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 17 kb)
Rights and permissions
About this article
Cite this article
Yoo, G., Leach, A., Woods, R. et al. Computed Tomography Practice Standards for Severe Pediatric Traumatic Brain Injury in the Emergency Department: a National Survey. Journ Child Adol Trauma 14, 271–276 (2021). https://doi.org/10.1007/s40653-020-00317-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40653-020-00317-x