Title : Guidelines application for the treatment of TBI in children A multidisciplinary approach
Abstract:
Introduction: The main aim of management of pediatric Severe Brain Injury (TBI) is to hold normal ranges for optimizing the most favorable outcomes.Clinical and research Institute of Emergency Pediatric Surgery and Trauma. Annually, more than 10000 children with head injury are consulted in the institute's admission department. The number of children with severe brain injury is not large, but these patients are very difficult for treatment (3%).
The aim of the study: is to demonstrate the effectiveness of using clinical recommendations and a multidisciplinary approach to the treatment of pediatric TBI. Since 2004, in our Institutebasic principles of sTBI curative strategies have been developed in compliance with contemporary guidelines. Additionally, we have developed the prognosis of outcomes which we utilize as a tool for treatment control. So, the philosophy of treating severe TBI includes some important tasks: control of intracranial and extracranial complications; ICP control, early surgical treatment of sTBI complication, including cranioplasty, acute and early rehabilitation, multidisciplinary approach.
Results: 311 patients (GCS 3-8) were admitted to our hospital from 2004 till 2018. 58% of them had combined trauma. All patients had ICP control. 97 p-ts had decompressive craniectomy. Early rehabilitation begins after stabilization of vital functions. 44% of patients had reconstructive surgeries because of extensive defects of the scull. The average time for defect closure was 58±12 days. 12% of patients were operated on for posttraumatic hydrocephaly. A month after the injury. good outcomes (GOS 4-5) were in 42%; 33.5% had GOS 3-4 ; .24.5% - GOS 1-2. 6 months later, 69% of survivors had good results.
Conclusion: Prognosis and outcomes are largely determined by a timely and fully provided specialized urgent medical aid. More than 30 different specialists may take part in the treatment-from paramedic to social worke. From this point of view, successive and continuous multidisciplinary approach is very important. The timely recovery and support of vital functions, “physiological corridor”, early surgical treatment of complications, early rehabilitation allow to optimize outcomes in children with severe traumatic brain injury.
