Differences in medical therapy goals for children with severe traumatic brain injury - An international study

Michael J. Bell, P. David Adelson, James S. Hutchison, Patrick M. Kochanek, Robert C. Tasker, Monica S. Vavilala, Sue R. Beers, Anthony Fabio, Sheryl F. Kelsey, Stephen R. Wisniewski, Laura Loftis, Kevin Morris, Kerri LaRovere, Philippe Meyer, Karen Walson, Jennifer Exo, Ajit Sarnaik, Todd Kilbaugh, Darryl Miles, Mark WainwrightNathan Dean, Ranjit Chima, Katherine Biagas, Mark Peters, Joan Balcells, Joan Sanchez Del Toledo, Courtney Robertson, Dwight Bailey, Lauren Piper, William Tsai, John Ragheb, Rachel Agbeko, Nicole O'Brien, Amber Young, Neal Thomas, Sandra Buttram, Santiago Borasino, JoAnne Natale, Christopher Giza, David Shellington, Deborah Stein, Robert Clark, Alicia Au, Jerry Zimmerman, Jose Pineda, Peter Ferrazzano

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

OBJECTIVES: To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury. DESIGN: A survey of the goals from representatives of the international centers. SETTING: Thirty-two pediatric traumatic brain injury centers in the United States, United Kingdom, France, and Spain. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A survey instrument was developed that required free-form responses from the centers regarding their usual practice goals for topics of intracranial hypertension therapies, hypoxia/ischemia prevention and detection, and metabolic support. Cerebrospinal fluid diversion strategies varied both across centers and within centers, with roughly equal proportion of centers adopting a strategy of continuous cerebrospinal fluid diversion and a strategy of no cerebrospinal fluid diversion. Use of mannitol and hypertonic saline for hyperosmolar therapies was widespread among centers (90.1% and 96.9%, respectively). Of centers using hypertonic saline, 3% saline preparations were the most common but many other concentrations were in common use. Routine hyperventilation was not reported as a standard goal and 31.3% of centers currently use PbO2 monitoring for cerebral hypoxia. The time to start nutritional support and glucose administration varied widely, with nutritional support beginning before 96 hours and glucose administration being started earlier in most centers. CONCLUSIONS: There were marked differences in medical goals for children with severe traumatic brain injury across our international consortium, and these differences seemed to be greatest in areas with the weakest evidence in the literature. Future studies that determine the superiority of the various medical therapies outlined within our survey would be a significant advance for the pediatric neurotrauma field and may lead to new standards of care and improved study designs for clinical trials.

Original languageEnglish (US)
Pages (from-to)811-818
Number of pages8
JournalPediatric Critical Care Medicine
Volume14
Issue number8
DOIs
StatePublished - Oct 2013

Fingerprint

Cerebrospinal Fluid
Nutritional Support
Pediatrics
Glucose
Brain Hypoxia
Intracranial Hypertension
Hyperventilation
Mannitol
Therapeutics
Standard of Care
Spain
France
Ischemia
Clinical Trials
Traumatic Brain Injury
Surveys and Questionnaires
Hypoxia
United Kingdom

Keywords

  • cerebral hypoperfusion
  • hypoxia
  • intracranial hypertension
  • pediatric neurocritical care
  • pediatric traumatic brain injury
  • secondary Injuries

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Bell, M. J., Adelson, P. D., Hutchison, J. S., Kochanek, P. M., Tasker, R. C., Vavilala, M. S., ... Ferrazzano, P. (2013). Differences in medical therapy goals for children with severe traumatic brain injury - An international study. Pediatric Critical Care Medicine, 14(8), 811-818. https://doi.org/10.1097/PCC.0b013e3182975e2f

Differences in medical therapy goals for children with severe traumatic brain injury - An international study. / Bell, Michael J.; Adelson, P. David; Hutchison, James S.; Kochanek, Patrick M.; Tasker, Robert C.; Vavilala, Monica S.; Beers, Sue R.; Fabio, Anthony; Kelsey, Sheryl F.; Wisniewski, Stephen R.; Loftis, Laura; Morris, Kevin; LaRovere, Kerri; Meyer, Philippe; Walson, Karen; Exo, Jennifer; Sarnaik, Ajit; Kilbaugh, Todd; Miles, Darryl; Wainwright, Mark; Dean, Nathan; Chima, Ranjit; Biagas, Katherine; Peters, Mark; Balcells, Joan; Del Toledo, Joan Sanchez; Robertson, Courtney; Bailey, Dwight; Piper, Lauren; Tsai, William; Ragheb, John; Agbeko, Rachel; O'Brien, Nicole; Young, Amber; Thomas, Neal; Buttram, Sandra; Borasino, Santiago; Natale, JoAnne; Giza, Christopher; Shellington, David; Stein, Deborah; Clark, Robert; Au, Alicia; Zimmerman, Jerry; Pineda, Jose; Ferrazzano, Peter.

In: Pediatric Critical Care Medicine, Vol. 14, No. 8, 10.2013, p. 811-818.

Research output: Contribution to journalArticle

Bell, MJ, Adelson, PD, Hutchison, JS, Kochanek, PM, Tasker, RC, Vavilala, MS, Beers, SR, Fabio, A, Kelsey, SF, Wisniewski, SR, Loftis, L, Morris, K, LaRovere, K, Meyer, P, Walson, K, Exo, J, Sarnaik, A, Kilbaugh, T, Miles, D, Wainwright, M, Dean, N, Chima, R, Biagas, K, Peters, M, Balcells, J, Del Toledo, JS, Robertson, C, Bailey, D, Piper, L, Tsai, W, Ragheb, J, Agbeko, R, O'Brien, N, Young, A, Thomas, N, Buttram, S, Borasino, S, Natale, J, Giza, C, Shellington, D, Stein, D, Clark, R, Au, A, Zimmerman, J, Pineda, J & Ferrazzano, P 2013, 'Differences in medical therapy goals for children with severe traumatic brain injury - An international study', Pediatric Critical Care Medicine, vol. 14, no. 8, pp. 811-818. https://doi.org/10.1097/PCC.0b013e3182975e2f
Bell, Michael J. ; Adelson, P. David ; Hutchison, James S. ; Kochanek, Patrick M. ; Tasker, Robert C. ; Vavilala, Monica S. ; Beers, Sue R. ; Fabio, Anthony ; Kelsey, Sheryl F. ; Wisniewski, Stephen R. ; Loftis, Laura ; Morris, Kevin ; LaRovere, Kerri ; Meyer, Philippe ; Walson, Karen ; Exo, Jennifer ; Sarnaik, Ajit ; Kilbaugh, Todd ; Miles, Darryl ; Wainwright, Mark ; Dean, Nathan ; Chima, Ranjit ; Biagas, Katherine ; Peters, Mark ; Balcells, Joan ; Del Toledo, Joan Sanchez ; Robertson, Courtney ; Bailey, Dwight ; Piper, Lauren ; Tsai, William ; Ragheb, John ; Agbeko, Rachel ; O'Brien, Nicole ; Young, Amber ; Thomas, Neal ; Buttram, Sandra ; Borasino, Santiago ; Natale, JoAnne ; Giza, Christopher ; Shellington, David ; Stein, Deborah ; Clark, Robert ; Au, Alicia ; Zimmerman, Jerry ; Pineda, Jose ; Ferrazzano, Peter. / Differences in medical therapy goals for children with severe traumatic brain injury - An international study. In: Pediatric Critical Care Medicine. 2013 ; Vol. 14, No. 8. pp. 811-818.
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abstract = "OBJECTIVES: To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury. DESIGN: A survey of the goals from representatives of the international centers. SETTING: Thirty-two pediatric traumatic brain injury centers in the United States, United Kingdom, France, and Spain. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A survey instrument was developed that required free-form responses from the centers regarding their usual practice goals for topics of intracranial hypertension therapies, hypoxia/ischemia prevention and detection, and metabolic support. Cerebrospinal fluid diversion strategies varied both across centers and within centers, with roughly equal proportion of centers adopting a strategy of continuous cerebrospinal fluid diversion and a strategy of no cerebrospinal fluid diversion. Use of mannitol and hypertonic saline for hyperosmolar therapies was widespread among centers (90.1{\%} and 96.9{\%}, respectively). Of centers using hypertonic saline, 3{\%} saline preparations were the most common but many other concentrations were in common use. Routine hyperventilation was not reported as a standard goal and 31.3{\%} of centers currently use PbO2 monitoring for cerebral hypoxia. The time to start nutritional support and glucose administration varied widely, with nutritional support beginning before 96 hours and glucose administration being started earlier in most centers. CONCLUSIONS: There were marked differences in medical goals for children with severe traumatic brain injury across our international consortium, and these differences seemed to be greatest in areas with the weakest evidence in the literature. Future studies that determine the superiority of the various medical therapies outlined within our survey would be a significant advance for the pediatric neurotrauma field and may lead to new standards of care and improved study designs for clinical trials.",
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AU - Bell, Michael J.

AU - Adelson, P. David

AU - Hutchison, James S.

AU - Kochanek, Patrick M.

AU - Tasker, Robert C.

AU - Vavilala, Monica S.

AU - Beers, Sue R.

AU - Fabio, Anthony

AU - Kelsey, Sheryl F.

AU - Wisniewski, Stephen R.

AU - Loftis, Laura

AU - Morris, Kevin

AU - LaRovere, Kerri

AU - Meyer, Philippe

AU - Walson, Karen

AU - Exo, Jennifer

AU - Sarnaik, Ajit

AU - Kilbaugh, Todd

AU - Miles, Darryl

AU - Wainwright, Mark

AU - Dean, Nathan

AU - Chima, Ranjit

AU - Biagas, Katherine

AU - Peters, Mark

AU - Balcells, Joan

AU - Del Toledo, Joan Sanchez

AU - Robertson, Courtney

AU - Bailey, Dwight

AU - Piper, Lauren

AU - Tsai, William

AU - Ragheb, John

AU - Agbeko, Rachel

AU - O'Brien, Nicole

AU - Young, Amber

AU - Thomas, Neal

AU - Buttram, Sandra

AU - Borasino, Santiago

AU - Natale, JoAnne

AU - Giza, Christopher

AU - Shellington, David

AU - Stein, Deborah

AU - Clark, Robert

AU - Au, Alicia

AU - Zimmerman, Jerry

AU - Pineda, Jose

AU - Ferrazzano, Peter

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N2 - OBJECTIVES: To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury. DESIGN: A survey of the goals from representatives of the international centers. SETTING: Thirty-two pediatric traumatic brain injury centers in the United States, United Kingdom, France, and Spain. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A survey instrument was developed that required free-form responses from the centers regarding their usual practice goals for topics of intracranial hypertension therapies, hypoxia/ischemia prevention and detection, and metabolic support. Cerebrospinal fluid diversion strategies varied both across centers and within centers, with roughly equal proportion of centers adopting a strategy of continuous cerebrospinal fluid diversion and a strategy of no cerebrospinal fluid diversion. Use of mannitol and hypertonic saline for hyperosmolar therapies was widespread among centers (90.1% and 96.9%, respectively). Of centers using hypertonic saline, 3% saline preparations were the most common but many other concentrations were in common use. Routine hyperventilation was not reported as a standard goal and 31.3% of centers currently use PbO2 monitoring for cerebral hypoxia. The time to start nutritional support and glucose administration varied widely, with nutritional support beginning before 96 hours and glucose administration being started earlier in most centers. CONCLUSIONS: There were marked differences in medical goals for children with severe traumatic brain injury across our international consortium, and these differences seemed to be greatest in areas with the weakest evidence in the literature. Future studies that determine the superiority of the various medical therapies outlined within our survey would be a significant advance for the pediatric neurotrauma field and may lead to new standards of care and improved study designs for clinical trials.

AB - OBJECTIVES: To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury. DESIGN: A survey of the goals from representatives of the international centers. SETTING: Thirty-two pediatric traumatic brain injury centers in the United States, United Kingdom, France, and Spain. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A survey instrument was developed that required free-form responses from the centers regarding their usual practice goals for topics of intracranial hypertension therapies, hypoxia/ischemia prevention and detection, and metabolic support. Cerebrospinal fluid diversion strategies varied both across centers and within centers, with roughly equal proportion of centers adopting a strategy of continuous cerebrospinal fluid diversion and a strategy of no cerebrospinal fluid diversion. Use of mannitol and hypertonic saline for hyperosmolar therapies was widespread among centers (90.1% and 96.9%, respectively). Of centers using hypertonic saline, 3% saline preparations were the most common but many other concentrations were in common use. Routine hyperventilation was not reported as a standard goal and 31.3% of centers currently use PbO2 monitoring for cerebral hypoxia. The time to start nutritional support and glucose administration varied widely, with nutritional support beginning before 96 hours and glucose administration being started earlier in most centers. CONCLUSIONS: There were marked differences in medical goals for children with severe traumatic brain injury across our international consortium, and these differences seemed to be greatest in areas with the weakest evidence in the literature. Future studies that determine the superiority of the various medical therapies outlined within our survey would be a significant advance for the pediatric neurotrauma field and may lead to new standards of care and improved study designs for clinical trials.

KW - cerebral hypoperfusion

KW - hypoxia

KW - intracranial hypertension

KW - pediatric neurocritical care

KW - pediatric traumatic brain injury

KW - secondary Injuries

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