Successful Conservative Management of Severe Traumatic Brain Injury in Children

Mohammad Jamali, Derakhshan Nima, Kamgarpour Ahmad, Moradi Ehsan


Background: Traumatic brain injury is a major cause of mortality and morbidity in pediatric age group. ICP monitoring and early decompressive craniectomy in cases that develop intracranial hypertension has been described to be the method of choice in many pediatric trauma centers. Here in, we propose a protocol with conservative measures for the management of patients with severe traumatic brain injury.

Methods: We managed a series of seven children who were successfully treated with this protocol between March 2013 and June 2013.

Our protocol consists of following treatment modalities:

>Intubation in all patients with severe TBI and using mechanical ventilation in all cases for the beginning

>Sedatives and analgesics and pain management

>Serial ABGs Q6h

>Hyperosmolar therapy via hypertonic saline 5%

>Correction of anemia, coagulopathy, hypoalbuminemia and maintaining normoglycemia

>Early initiation of p.o. feeding via OG tube

>Avoiding hypothermia

>early detection of fever and extensive fever work-up and management of infections

>Management of spasm

>Postponing tracheostomy till up to 21 days

>Avoiding EVD for ICP monitoring and relying on radiologic surveillance and clinical judgment especially the size and reaction of pupils

Results: Of 7 children managed by this protocol all patients were discharged with favorable condition. None of these patients underwent decompressive craniectomy, ventriculostomy for ICP monitoring and tracheostomy.

Conclusion: Adelson et al published a guideline in 2003 for management of children with severe TBI which further evidence-based analysis marked no measures as "standard", three as" guidelines" and other recommendations as "options". Conservative management of children with severe TBI is not only cost-beneficial but also provides favorable outcomes. Radiologic surveillance and clinical judgement remains superior to ICP monitoring due to lower risk of fatal infections.

Keywords: Severe traumatic brain injury, conservative, children


Severe traumatic brain injury, conservative, children