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Minerva Anestesiologica 2021 May;87(5):567-79

DOI: 10.23736/S0375-9393.20.14122-1


language: English

The management of pediatric severe traumatic brain injury: Italian Guidelines

Leonardo BUSSOLIN 1, Martina FALCONI 2, Maria C. LEO 2, Niccolò PARRI 3 , Salvatore DE MASI 4, Anna ROSATI 5, Costanza CECCHI 6, Barbara SPACCA 7, Manuela GRANDONI 7, Alessandra BETTIOL 8, Ersilia LUCENTEFORTE 9, Riccardo LUBRANO 10, 11, Raffaele FALSAPERLA 10, 12, Francesca MELOSI 6, 13, Rino AGOSTINIANI 14, Francesca MANGIANTINI 14, Giuseppe TALAMONTI 15, Edoardo CALDERINI 16, Aldo MANCINO 17, Marco DE LUCA 18, Giorgio CONTI 18, 19, Flavia PETRINI 14, Guideline Working Group 

1 Neuroanesthesiology, Intensive Care and Trauma Center, A. Meyer University Hospital, Florence, Italy; 2 Techical-Scientific Secretary, Pediatric Regional and Ethical Committee, A. Meyer University Hospital, Florence, Italy; 3 Emergency Department and Trauma Center, A. Meyer University Hospital, Florence, Italy; 4 Clinical Trial Office, A. Meyer University Hospital, Florence, Italy; 5 Neurosciences Excellence Center, A. Meyer University Hospital, Florence, Italy; 6 Anestesiology and Intensive Care Unit, A. Meyer University Hospital, Florence, Italy; 7 Unit of Neurosurgery, A. Meyer University Hospital, Florence, Italy; 8 University of Florence, Florence, Italy; 9 University of Pisa, Pisa, Italy; 10 Società Italiana di Medicina Emergenza Urgenza Pediatrica (SIMEUP), Milan, Italy; 11 Pediatrics Unit, Pediatric Emergency Department, Neonatology and Neonatal Intensive Care, “Rodolico-San Marco” University Hospital, Catania, Italy; 12 Pediatrics and Neonatology Unit, Department of Maternal and Urological Sciences, Sapienza University, Latina, Rome, Italy; 13 Società Italiana di Neurosonologia ed Emodinamica Cerebrale (SINSEC), Bologna, Italy; 14 Società Italiana di Pediatria (SIP), Rome, Italy; 15 Società Italiana di Neurochirurgia (SINCH), Rimini, Italy; 16 Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Rome, Italy; 17 Società di Anestesia e Rianimazione Neonatale e Pediatrica Italiana (S.A.R.N.eP.I), Rome, Italy; 18 Accademia Medica ed Infermieristica di Emergenza e Terapia Intensiva Pediatrica (AMIETIP), Bologna, Italy; 19 IRCCS A. Gemelli, Catholic University, Rome, Italy

INTRODUCTION: The aim of the work was to update the “Guidelines for the Management of Severe Traumatic Brain Injury” published in 2012, to reflect the new available evidence, and develop the Italian national guideline for the management of severe pediatric head injuries to reduce variation in practice and ensure optimal care to patients.
EVIDENCE ACQUISITION: MEDLINE and EMBASE were searched from January 2009 to October 2017. Inclusion criteria were English language, pediatric populations (0-18 years) or mixed populations (pediatric/adult) with available age subgroup analyses. The guideline development process was started by the Promoting Group that composed a multidisciplinary panel of experts, with the representatives of the Scientific Societies, the independent expert specialists and a representative of the Patient Associations. The panel selected the clinical questions, discussed the evidence and formulated the text of the recommendations. The documentarists of the University of Florence oversaw the bibliographic research strategy. A group of literature reviewers evaluated the selected literature and compiled the table of evidence for each clinical question.
EVIDENCE SYNTHESIS: The search strategies identified 4254 articles. We selected 3227 abstract (first screening) and, finally included 67 articles (second screening) to update the guideline. This Italian update includes 25 evidence-based recommendations and 5 research recommendations.
CONCLUSIONS: In recent years, progress has been made on the understanding of severe pediatric brain injury, as well as on that concerning all major traumatic pathology. This has led to a progressive improvement in the clinical outcome, although the quantity and quality of evidence remains particularly low.

KEY WORDS: Brain injuries, traumatic; Glasgow Coma Scale; Pediatrics; Guideline

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