title: Scandinavian guidelines for initial management of minor and moderate head trauma in children.
abstract: BACKGROUND
  The management of minor and moderate head trauma in children differs widely between countries. Presently, there are no existing guidelines for management of these children in Scandinavia. The purpose of this study was to produce new evidence-based guidelines for the initial management of head trauma in the paediatric population in Scandinavia. The primary aim was to detect all children in need of neurosurgical intervention. Detection of any traumatic intracranial injury on CT scan was an important secondary aim.
  
  
  METHODS
  General methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used. Systematic evidence-based review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and based upon relevant clinical questions with respect to patient-important outcomes. Quality ratings of the included studies were performed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and Centre of Evidence Based Medicine (CEBM)-2 tools. Based upon the results, GRADE recommendations, a guideline, discharge instructions and in-hospital observation instructions were drafted. For elements with low evidence, a modified Delphi process was used for consensus, which included relevant clinical stakeholders.
  
  
  RESULTS
  The guidelines include criteria for selecting children for CT scans, in-hospital observation or early discharge, and suggestions for monitoring routines and discharge advice for children and guardians. The guidelines separate mild head trauma patients into high-, medium- and low-risk categories, favouring observation for mild, low-risk patients as an attempt to reduce CT scans in children.
  
  
  CONCLUSIONS
  We present new evidence and consensus based Scandinavian Neurotrauma Committee guidelines for initial management of minor and moderate head trauma in children. These guidelines should be validated before extensive clinical use and updated within four years due to rapid development of new diagnostic tools within paediatric neurotrauma.
authors.affiliation: Department of Neurosurgery, Neurocenter 2091, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. raastrand@gmail.com.
authors.forename: Ramona
authors.initials: R
authors.lastname: Astrand
authors.affiliation: Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
authors.forename: Christina
authors.initials: C
authors.lastname: Rosenlund
authors.affiliation: Department of Intensive Care and Perioperative Medicine, Institute for Clinical Sciences, Skåne University Hospital, Södra Förstadsgatan 101, 20502, Malmö, Sweden. dr.johan.unden@gmail.com.
authors.forename: Johan
authors.initials: J
authors.lastname: Undén
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D006259:Craniocerebral Trauma / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D003422:Critical Care / Q000592:standards*; D005006:Ethnicity; D019317:Evidence-Based Medicine / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D011379:Prognosis; D012196:Review Literature as Topic; D012537:Scandinavian and Nordic Countries; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices