Critical Update on the Third Edition of the Guidelines for Managing Severe Traumatic Brain Injury in Children

Karin Reuter-Rice, PhD, CPNP-AC; Elise Christoferson, BA


Am J Crit Care. 2020;29(1):e13-e18. 

In This Article

Critical Update of an Evidence-based Guideline on Pediatric Severe TBI

The third edition of the guidelines for the management of pediatric severe TBI aims to optimize and standardize evidence-based care of children with severe TBI with a methodologically, rigorously updated (2010–2017) systematic review that incorporated 48 new studies. The new and existing evidence resulted in 22 level II or III evidence-based recommendations. Eight new recommendations now support interventions for neuroimaging, hyperosmolar therapy, analgesics and sedatives, seizure prophylaxis, temperature control, and nutrition. The third edition of the guidelines provides recommendations on monitoring, thresholds, and treatments in children ages 0 to 18 years with TBI and GCS scores less than 9. Three primary end points are addressed: (1) outcomes including mortality, morbidity, and function; (2) control of ICP; and (3) prevention of posttraumatic seizures. The third edition of the guidelines is available for free and can be accessed at 3rd Edition Guidelines for the Management of Pediatric Severe TBI. An executive summary is also available in the journals Neurosurgery and Pediatric Critical Care Medicine. A companion algorithm was also developed to supplement the recommendations with expert consensus and organization of interventions and can be found at Management of Pediatric Severe TBI: Guidelines-Based Algorithm.[9]