TBI (Paed) CPG Notes Flashcards
(14 cards)
What are the care objectives in managing paediatric TBI?
Optimise airway, oxygenation, ventilation, and cerebral perfusion pressure in moderate-severe TBI.
* Triage high-risk patients to neurosurgical facilities
* Transport moderate-risk patients to ED for CT/observation
* Refer low-risk patients to self-care and community follow-up
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Who does this guideline apply to?
Patients aged < 16 with a potential traumatic head injury
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What criteria define a paediatric head injury as high-risk?
Altered mental status: GCS < 15 or agitation
* Penetrating head injury
* High-risk features: LOC > 5 min, skull fracture, seizure (not at time of impact), worsening symptoms, neurological deficits (e.g., numbness, weakness, ataxia, clumsiness, double vision)
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How should high-risk patients be managed?
As per CPG P0806 Major Trauma:
* Airway: Maintain patency, consider adjuncts only if needed
* Breathing: Target normal SpO₂ and ETCO₂
* Circulation: Maintain normal or supranormal BP
* Supportive care: Raise head of stretcher 10–15°
* Transport to the highest level trauma centre within 60 minutes (CPG P0105)
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What are signs of a basal skull fracture?
Haemotympanum
* CSF leakage from nose/ears
* Battle sign
* Raccoon eyes
(Note: May take up to 3 days to appear)
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What are moderate risk features in paediatric TBI?
Repetitive questioning, slow response
* Acting abnormally (under age 2)
* Dangerous MOI: MCA > 30 km/h, high-speed MCA > 60 km/h, pedestrian impact, ejection from vehicle, prolonged extrication, fall > 3 m, hit by object falling > 3 m, explosion, intoxication, coagulopathy/anticoagulant use (not aspirin), severe headache, vomiting > once, LOC, non-frontal scalp haematoma (age < 2), age < 6 months, VP shunt, neurodevelopmental disorders
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What should be done if only the following risk factors are present?
Consider consulting VVED if:
* Multiple vomits
* Scalp haematomas
* Neurodevelopmental disorders
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What is the disposition for moderate risk?
Transport to CT-capable hospital or observe for 4 hours
* Consider shared decision-making with VVED if uncertain
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What defines a low-risk paediatric TBI?
No high or moderate risk features
* Competent adult available to supervise for at least 4 hours
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What is the management for a low-risk patient with concussion symptoms?
Self-care advice:
* Rest (limit screen/physical activity)
* Paracetamol for headache
* No driving, alcohol, or sedatives for 24 hrs
* Monitor with a competent adult for at least 4 hours (ideally 24)
* GP follow-up in 2–3 days
* Provide health info sheet
* Safety netting
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When should safety netting advice be given?
For all low-risk patients—concussed or asymptomatic
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What symptoms warrant seeking immediate help?
Severe/increasing headache
* Repeated vomiting
* Confusion or agitation
* LOC or inability to wake
* Seizures
* Limb weakness or altered sensation
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Is follow-up required if the patient has no concussion symptoms?
No. Safety netting and a health information sheet is sufficient
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What ongoing monitoring is recommended during transport for TBI patients?
Pupil checks every 15 minutes
* Full baseline monitoring per CPG A0101 Clinical Approach
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