title: Differences in medical therapy goals for children with severe traumatic brain injury-an international study.
abstract: OBJECTIVE
  To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury.
  
  
  METHODS
  A survey of the goals from representatives of the international centers.
  
  
  METHODS
  Thirty-two pediatric traumatic brain injury centers in the United States, United Kingdom, France, and Spain.
  
  
  METHODS
  None.
  
  
  METHODS
  None.
  
  
  RESULTS
  A survey instrument was developed that required free-form responses from the centers regarding their usual practice goals for topics of intracranial hypertension therapies, hypoxia/ischemia prevention and detection, and metabolic support. Cerebrospinal fluid diversion strategies varied both across centers and within centers, with roughly equal proportion of centers adopting a strategy of continuous cerebrospinal fluid diversion and a strategy of no cerebrospinal fluid diversion. Use of mannitol and hypertonic saline for hyperosmolar therapies was widespread among centers (90.1% and 96.9%, respectively). Of centers using hypertonic saline, 3% saline preparations were the most common but many other concentrations were in common use. Routine hyperventilation was not reported as a standard goal and 31.3% of centers currently use PbO(2) monitoring for cerebral hypoxia. The time to start nutritional support and glucose administration varied widely, with nutritional support beginning before 96 hours and glucose administration being started earlier in most centers.
  
  
  CONCLUSIONS
  There were marked differences in medical goals for children with severe traumatic brain injury across our international consortium, and these differences seemed to be greatest in areas with the weakest evidence in the literature. Future studies that determine the superiority of the various medical therapies outlined within our survey would be a significant advance for the pediatric neurotrauma field and may lead to new standards of care and improved study designs for clinical trials.
authors.affiliation: 1Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. 2Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA. 3Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA. 4Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ. 5Department of Critical Care Medicine, University of Toronto, Toronto, CA. 6Department of Neurology, Harvard Medical School, Boston, MA. 7Department of Anesthesia, Harvard Medical School, Boston, MA. 8Division of Critical Care, Boston Children's Hospital, Boston, MA. 9Department of Anesthesia, University of Washington, Seattle, WA. 10Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA. 11Department of Epidemiology and Biostatistics, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bell
authors.forename: P David
authors.initials: PD
authors.lastname: Adelson
authors.forename: James S
authors.initials: JS
authors.lastname: Hutchison
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kochanek
authors.forename: Robert C
authors.initials: RC
authors.lastname: Tasker
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.forename: Sue R
authors.initials: SR
authors.lastname: Beers
authors.forename: Anthony
authors.initials: A
authors.lastname: Fabio
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000188:drug therapy* / Q000628:therapy; D002648:Child; D019468:Disease Management; D005060:Europe; D006040:Goals; D006306:Health Surveys; D006801:Humans; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome; D014481:United States