Australia and New Zealand’s first set of clinical guidelines for pediatric head injuries have been developed by a network of specialists based at the Murdoch Children’s Research Institute (MCRI).
The manual, developed by the Pediatric Research in Emergency Departments International Collaborative (PREDICT) and published in Australasia Emergency Medicine, will enable emergency physicians to diagnose and treat children’s head injuries while reducing unnecessary ones radiation exposure from a CT scan. They also treat head injuries in children with underlying problems, such as bleeding disorders.
Matthew Salter took his son Jakob, 15, to the emergency department of a large hospital late last year after he hit his head after a BMX accident.
Jakob tries to do a bike trick on one of our local BMX tracks but he missteps landing and crashes first. When my wife and I arrived at the scene, we found her helmet shield had been destroyed, she was depressed and I was worried she might have a concussion. When we arrived at the hospital he vomited several times so to confirm a head injury he received a CT scan and was observed overnight. “
Mr. Matthew Salter
Based on the new head injury guidelines, Jakob fulfills several risk factors for CT scan and observation.
Mr Salter said it was comforting to know these guidelines were in place to ensure all children receive the same treatment wherever they live in Australia.
Professor Franz Babl, Leader of the MCRI Emergency Research Group, said Australia and New Zealand do not yet have specific guidelines to help doctors decide how best to treat every child under 18 who comes to the emergency department with mild to moderate head injuries.
“Even though we need to rule out bleeding in the brain, we don’t want to order a CT scan unnecessarily, because it increases the lifetime radiation exposure of children,” he said.
“The lack of standardized guidelines means children receive different treatments depending on where they are seen. Broad adoption of these guidelines will change that.”
Following an extensive search and assessment of international guidelines such as those used in Canada, the US and the UK, the PREDICT working group developed 71 recommendations and imaging / observation algorithms relevant to the Australian and New Zealand setting. The new guidelines cover patient triage, imaging, observation versus admission, transfer, discharge and follow-up.
Head injuries are one of the most common reasons children come to the emergency department.
In Australia and New Zealand about 10 per cent of children who present with head injuries of all severity undergo CT scans. Although traumatic brain injury is rare, persistent post-concussion symptoms affect more than a third.
Professor Stuart Dalziel, Chair of Cure Kids Child Health Research at The University of Auckland and pediatric emergency doctor at Starship Children’s Hospital in New Zealand, said identifying traumatic brain injuries in children with seemingly minor injuries could be difficult and over the past 15 years has occurred. research focus in emergency departments around the world.
He said across Australia and New Zealand there had been variations in practice in the management of child head injuries.
The PREDICT working group that developed the guidelines includes emergency physicians, pediatricians, neurologists, neurosurgeons, radiologists, sports medicine doctors, neurologists, general practitioners, paramedics and nurses.
Guidelines can be found at predict.org.au