In this episode, Dr. Banerjee and I explore a protocol being trialed for pediatric patients suffering from moderate to severe traumatic brain injuries (TBI). This initiative, a collaboration with Arnold Palmer Hospital, introduces the pre-hospital administration of Keppra and 3% saline to provide treatment that the hospital would provide in the prehospital setting in hopes of optimizing patient outcomes.
Show Notes:
Traumatic brain injuries in children can range from mild concussions to severe impairments that affect them for life. Early intervention is crucial in mitigating the most serious consequences of these injuries, which is why advancements in initial care are so important.
Dr. Banerjee's department is testing a protocol that is simple in concept yet sophisticated in its potential impact. When first responders identify a child with signs of severe brain trauma, their treatment plan now includes administering hypertonic saline and Keppra. Here’s why this matters:
Hypertonic Saline: This solution osmotically reduces cerebral swelling by drawing excess fluid from the brain tissue, thereby lowering intracranial pressure that could otherwise exacerbate the injury.
Keppra: Targeting seizure prevention, Keppra addresses one of the common and critical complications of severe brain injuries. Preventing early post-traumatic seizures can significantly influence the overall outcome by stabilizing the patient sooner.
The prognosis for children with moderate to severe TBI has historically been concerning, with many facing long-term cognitive and physical challenges. This new protocol aims to shift these outcomes by enhancing the effectiveness of the initial response. Success is measured using the Modified Rankin Score, providing a quantitative assessment of disability during hospital discharge.
Adopting such a protocol involves more than just a procedural update; it requires comprehensive training for paramedics, appropriate stocking of emergency vehicles, and seamless integration with hospital procedures to ensure continuity of care. The collaboration and dedication across teams are vital to the success of this initiative.
The preliminary results from this protocol are promising, not only in improving survival rates but also in enhancing quality of life post-recovery. These findings could set a new standard for managing pediatric TBI nationally.
This protocol represents a significant advancement in emergency pediatric care, reflecting a commitment to improving long-term outcomes for pediatric TBI's.
References:
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Araki, T., Yokota, H., & Morita, A. (2017). Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis, and Management. Neurologia medico-chirurgica, 57(2), 82–93. https://doi.org/10.2176/nmc.ra.2016-0191
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Shi, J., Tan, L., Ye, J., & Hu, L. (2020). Hypertonic Saline and Mannitol in Patients With Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Medicine, 99(35), e21655. https://doi.org/10.1097/MD.0000000000021655
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