Pediatric traumatic brain injury—a review of management strategies

Management of traumatic brain injury (TBI) in children varies due to differing physician practices and availability of resources. Optimizing treatment to meet the physiologic demands of the wounded brain is crucial to achieve maximal recovery and minimize secondary injury. This review aims to discuss and update the different aspects of acute care in a child with TBI. A literature search for relevant original and review articles was carried out via PubMed. Relevant literatures from adult studies were included where there was a lack of pediatric data. Case reports and non-English articles were excluded. Acute airway management with carefully chosen sedative agents, appropriate ventilation and hyperosmolar therapy strategies are targeted at maintaining normal cerebral perfusion pressure (CPP). The goal of temperature control and glycemic control is to maintain normal ranges to optimize outcomes. Decisions for neuroimaging and initiation of anticonvulsants are weighed against potential complications. Achieving a beneficial neurological outcome for pediatric patients with TBI depends on effective management from the onset of injury. More high quality collaborative prospective research is required to develop individualized management strategies for our pediatric TBI patients in the acute setting.