Computed Tomography Practice Standards for Severe Pediatric Traumatic Brain Injury in the Emergency Department: a Nation
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ORIGINAL ARTICLE
Computed Tomography Practice Standards for Severe Pediatric Traumatic Brain Injury in the Emergency Department: a National Survey Gloria Yoo 1 & Andrew Leach 2 & Rob Woods 2 & Tanya Holt 3 & Gregory Hansen 3,4 Accepted: 21 July 2020 # Springer Nature Switzerland AG 2020
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. Keywords Brain injuries . Traumatic . Pediatric . Quality improvement . Tomography, X-ray computed
Severe traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality in pediatrics (Centers of Disease Control 2019); Public Health Agency of Canada 2018; Taylor et al. 2017). Acute medical management is directed by evidence-based guidelines that have been shown to improve patient outcomes (Kochanek et al. 2019; Tilford et al. 2005). When implementing and adhering to the Brain Trauma Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40653-020-00317-x) contains supplementary material, which is available to authorized users. * Gregory Hansen [email protected] 1
Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
2
Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
3
Division of Pediatric Critical Care, Jim Pattison Children’s Hospital, Saskatoon, Saskatchewan, Canada
4
Pediatric Intensive Care Unit, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada
Foundation’s (BTF) guidelines for severe pediatric TBI, reduced mortality and improved neurological status were the most significant outcomes (Alkhoury and Kyriakides 2014; Khormi et al. 2018; Palmer et al. 2001; O’Lynnger et al. 2016; Arabi et al. 2010; Talving et al. 2
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