A new study examining pediatric traumatic brain injury in Argentina found that following intensive care unit TBI treatment guidelines was associated with better outcomes. The two guidelines most strongly associated with favorable discharge outcomes were prevention of hypoxia and timely nutrition, findings which the authors noted were similar to results in another study conducted at pediatric trauma centers in the United States.
However, the study also found that overall TBI guidelines were followed inconsistently among the studied Argentina sites. The analysis included 117 patients previously enrolled in a seven-center study of children with severe TBI, and adherence to best TBI practice ranged from 55.6 percent to 83.7 percent.
“Intensive care treatments associated with favorable discharge outcomes in Argentine children with severe traumatic brain injury: For the South American Guideline Adherence Group,” published in PLOS ONE in December, was led by HIPRC Director and Traumatic Brain Injury section lead Monica Vavilala, M.D., and co-authors included HIPRC Research Consultant Qian Qiu, MBA, as well as researchers from across the U.S. and Argentina.
Other measured indicators included whether intracranial pressure (ICP) was monitored, whether systolic hypotension was avoided, whether antiepileptic drugs were administered and whether steroids were used. The indicators were chosen based on both TBI guidelines and the scope of local practice at the seven studied centers.
The authors noted that, even though they found a high number of children with high intracranial pressure on ICU admission, the centers used hyperosmolar therapy at disproportionally low rates.
“This is problematic because use of hyperosmolar therapy at the bedside can be life-saving and the lower use may reflect its lack of availability, lack of provider knowledge on how to use these medications, decision to not treat for reasons of futility and/or decision to treat in only certain TBI cases,” the authors wrote.
They went on to say that 40 percent of the studied patients who were admitted to the ICU were ultimately discharged with a disability, raising the question whether increased use of hyperosmolar therapy could have improved these outcomes.
Overall, the authors called for strategies to more fully implement TBI guidelines at the studied sites, particularly for guidelines around hypoxia and nutrition.
“Benchmarking Prehospital and Emergency Department Care for Argentine Children with Traumatic Brain Injury: For the South American Guideline Adherence Group.” PLoS One, Dec. 22, 2016, Vavilala MS, Lujan SB, Qiu Q, Petroni GJ, Ballarini NM, Guadagnoli N, Depetris MA, Faguaga GA, Baggio GM, Busso LO, García ME, González Carrillo OR, Medici PL, Sáenz SS, Vanella EE, Fabio A, Bell MJ.
“Postdischarge Care of Pediatric Traumatic Brain Injury in Argentina: A Multicenter Randomized Controlled Trial.” Pediatric Critical Care Medicine, July 2016, Carney NA, Petroni GJ, Luján SB, Ballarini NM, Faguaga GA, du Coudray HE, Huddleston AE, Baggio GM, Becerra JM, Busso LO, Dikmen SS, Falcone R, García ME, González Carrillo OR, Medici PL, Quaglino MB, Randisi CA, Sáenz SS, Temkin NR, Vanella EE.