Children across the developmental spectrum with mild, moderate, or severe TBI
Care Setting
Global settings including high-income and low- and middle-income countries with variable resource availability
Key Highlights
pTBI is a leading cause of death and disability in children worldwide with a likely underestimated incidence, especially in low-resource settings.
Current management evidence is limited and largely extrapolated from adult data, with a lack of high-quality paediatric-specific clinical guidelines.
Recent advances include biomarker identification and a new NINDS TBI classification system, but persistent evidence gaps remain for paediatric-specific recommendations.
Guideline-Based Recommendations
Diagnosis
Use age-appropriate assessment tools recognizing physiological and developmental differences from adults.
Incorporate clinical symptoms, imaging, and emerging blood-based biomarkers to improve diagnostic accuracy.
Consider social determinants of health in diagnostic evaluation.
Management
Apply evidence-based guidelines cautiously due to limited paediatric-specific data; most recommendations are level III evidence.
Tailor interventions to developmental stage and injury severity (mild, moderate, severe).
Address rehabilitation needs and integrate comprehensive systems of care adapted to resource availability.
Monitoring & Follow-up
Track long-term neurodevelopmental outcomes given complexity of recovery pathways.
Use biomarkers and imaging to monitor disease progression and recovery where available.
Implement longitudinal outcome tracking to inform clinical decision-making.
Risks
Underreporting and lack of standardized data may delay diagnosis and treatment.
Disparities in care and infrastructure in LMICs increase risk of poor outcomes.
Inadequate evidence base limits optimized therapeutic strategies.
Patient & Prescribing Data
Children with traumatic brain injury across all severities globally, including resource-limited settings
Current treatments are guided by limited paediatric-specific evidence; need for developmentally informed and context-appropriate interventions is critical.
Clinical Best Practices
Adopt an age-appropriate, developmentally informed approach to assessment and management of pTBI.
Incorporate multidisciplinary care models including rehabilitation and psychosocial support.
Address social determinants of health and resource disparities to improve equity in care.
Utilize emerging biomarkers and neuroimaging to enhance diagnosis and outcome prediction.
Promote global research collaboration to generate high-quality paediatric-specific evidence.
by Shruti Agrawal, Rebekah Mannix, Vicki Anderson, Miriam H Beauchamp, Adam Ferguson, Lucia W Braga, Shu-Ling Chong, Anthony Figaji, Christopher Giza, David K Menon, Michael J Bell
