Author Of 1 Presentation
VARIABILITY IN TRAUMATIC BRAIN INJURY MANAGEMENT GUIDELINES ACROSS THE UK PAEDIATRIC INTENSIVE CARE UNITS
Abstract
Background
The 2012 Brain Trauma Foundation (BTF) guidelines for severe traumatic brain injury (TBI) in infants, children and adolescents (2nd edition) provided recommendations for management in paediatric intensive care units (PICU). However, weak recommendations based on low quality evidence can lead to variability in clinical practice.
Objectives
Describe the variability of individual UK PICU TBI guidelines compared to BTF guidelines and/or each other.
Methods
Current TBI guidelines were requested from 17 UK PICUs. Guidelines were anonymised and analysed for consistency in 12 key areas of clinical practice.
Results
12/17 (71%) UK PICU TBI guidelines were received. None of the guidelines were entirely consistent with the BTF. Widespread variability was observed in all analysed areas of clinical practice including intracranial, cerebral perfusion pressure thresholds and intracranial hypertension management strategies (Figure 1). Of note, none of the analysed guidelines recommended the choice of 6.5-10mL/kg 3% hypertonic saline suggested by BTF for bolus dose of hyperosmotic therapy. Most of the guidelines (83%) recommended decompressive craniectomy as a rescue option in refractory intracranial hypertension, consistent with BTF. However, lack of clarity about exact timing, indication and surgical technique were widely observed.
Conclusion
Current UK PICUs TBI guidelines differ significantly with BTF recommendations and amongst each other. There is potential for significant differences in clinical practice and the need for higher quality data to inform recommendations.
Presenter of 1 Presentation
VARIABILITY IN TRAUMATIC BRAIN INJURY MANAGEMENT GUIDELINES ACROSS THE UK PAEDIATRIC INTENSIVE CARE UNITS
Abstract
Background
The 2012 Brain Trauma Foundation (BTF) guidelines for severe traumatic brain injury (TBI) in infants, children and adolescents (2nd edition) provided recommendations for management in paediatric intensive care units (PICU). However, weak recommendations based on low quality evidence can lead to variability in clinical practice.
Objectives
Describe the variability of individual UK PICU TBI guidelines compared to BTF guidelines and/or each other.
Methods
Current TBI guidelines were requested from 17 UK PICUs. Guidelines were anonymised and analysed for consistency in 12 key areas of clinical practice.
Results
12/17 (71%) UK PICU TBI guidelines were received. None of the guidelines were entirely consistent with the BTF. Widespread variability was observed in all analysed areas of clinical practice including intracranial, cerebral perfusion pressure thresholds and intracranial hypertension management strategies (Figure 1). Of note, none of the analysed guidelines recommended the choice of 6.5-10mL/kg 3% hypertonic saline suggested by BTF for bolus dose of hyperosmotic therapy. Most of the guidelines (83%) recommended decompressive craniectomy as a rescue option in refractory intracranial hypertension, consistent with BTF. However, lack of clarity about exact timing, indication and surgical technique were widely observed.
Conclusion
Current UK PICUs TBI guidelines differ significantly with BTF recommendations and amongst each other. There is potential for significant differences in clinical practice and the need for higher quality data to inform recommendations.