Tratamiento prehospitalario y de urgencias del traumatismo craneoencefálico pediátrico: estudio multicéntrico

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2023

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Duke-NUS Medical School, Singapore
Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, SingHealth Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore
Pediatric Intensive Care Unit, Children’s Hospital “Sor Maria Ludovica”, Buenos Aires, Argentina
Pediatric Collaborative Latin American Network (LARed Network), Argentina
Pediatric Intensive Care Unit, Los Cobos Medical Center, Universidad del Bosque, Bogotá, Colombia
Department of Pediatrics, Pediatric Intensive Care Unit, Hospital Pereira Rossell, School of Medicine, University of the Republic, Montevideo, Uruguay
Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore
Emergency Department, National Children’s Hospital “Dr. Carlos Saenz Herrera”, CCSS, San José, Costa Rica
Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
Department of Paediatrics, Ministry of National Guards Health Affairs, Riyadh, Saudi Arabia
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
KK Research Centre, KK Women’s and Children’s Hospital, Singapore
Department of Emergency Medicine, KK Women’s and Children’s Hospital, SingHealth Paediatrics Academic Clinical Programme, SingHealth Emergency Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
Pediatric Intensive Care Unit, Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina
Argentina Intensive Care Society (SATI), Buenos Aires, Argentina
Pediatric Intensive Care Update Program (PROTIPED), Editorial Médica Panamericana, Buenos Aires, Argentina
Master’s Degree Higher Education for Health Professionals, University Institute School of Medicine of the Italian Hospital (IUHI), Buenos Aires, Argentina
Department of Pediatrics and Pediatric Critical Care Medicine, Hospital Nacional Hipolito Unanue, El Agustino, Peru
Pediatric Intensive Care Medicine Subspecialty, National University of San Marcos, Lima, Peru
Pediatric Chapter of the Peruvian Society of Intensive Care Medicine, Lima, Peru
Pediatric Intensive Care Unit, Cruses University Hospital, Bizkaia, Barakaldo, Spain
Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia
Pediatric and Neonate Intensive Care Unit, Maternal and Child Hospital, La Paz, Bolivia
Pediatric Critical Care, Clinica UROS, Huila, Neiva, Colombia
Department of Pediatrics, Pediatric Critical Care Division, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
Department of Emergency Medicine, National Children’s Hospital “Dr. Carlos Saenz Herrera”, San José, Costa Rica
Pediatric Critical Care, Mexican Institute of Social Security, México City, Mexico
Pediatric Critical Care Unit, HIAEP Sor María Ludovica, La Plata, Buenos Aires, Argentina
Pediatric Intensive Care Unit, General Hospital of Medellín “Luz Castro de Gutiérrez”, Medellín, Colombia
Pediatrics Department, UKM Specialist Children’s Hospital, Wilayah Persekutuan, Kuala Lumpur, Malaysia
Pediatric Intensive Care Unit, Children’s Hospital “Manuel Ascencio Villarroel”, Cochabamba, Bolivia
Critical Care Unit (CINP), Medica Uruguaya, Montevideo, Uruguay
Pediatric Intensive Care Unit, Pediatrics Department, Virgen de la Arrixaca Hospital, Murcia, Spain
Pediatrics Department, Misericordia Foundation Hospital, National University of Colombia, Bogota, Colombia
Pediatric Department, Shengjing Hospital, China Medical University, Liaoning, Shenyang, China
Department of Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, Shanghai, China
Department of Pediatric Intensive Care Unit, Children’s Hospital of Chongqing Medical University, Chongqing, China
Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
Pediatric Intensive Care Unit, Children’s Hospital Los Angeles, Pasto, Colombia
Pediatric Department, Universidad de Nariño, Pasto, Colombia
Emergency Department, Hospital del Trauma, Asunción, Paraguay
Pediatric Intensive Care Unit, Fundación Valle del Lili Hospital, Valle del Cauca, Cali, Colombia

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OBJETIVO Existe una escasez de información sobre la atención al traumatismo craneoencefálico (TCE) pediátrico en Asia y Latinoamérica. En este estudio, los autores se propusieron describir las prácticas clínicas de los servicios de urgencias (SU) participantes en el estudio Saline in Asia and Latin-America Neurotrauma in the Young (SALTY), comparando los centros de trauma designados (CTD) y los centros no traumatológicos (CNT) de sus redes. MÉTODOS Los autores llevaron a cabo un estudio de encuesta sobre el manejo del TCE pediátrico en los SUH de 14 países. Dos centros europeos se unieron a otros centros participantes de Asia y Latinoamérica. Las preguntas se formularon tras una revisión crítica de las directrices actuales sobre LCT y las encuestas publicadas. Los autores realizaron un análisis descriptivo y estratificaron los centros en función del estado de la LCT. RESULTADOS De los 24 centros que respondieron (70,6%), el 50,0% eran CDT, el 70,8% tenían afiliaciones académicas y todos los centros se encontraban en entornos urbanos. Los servicios prehospitalarios centralizados trasladaron predominantemente a los pacientes a los CTD en comparación con los enviados a los CNT (83,3% frente a 41,7%, p = 0,035). Un mayor número de CNT recibió a la mayoría de sus pacientes directamente desde el lugar del traumatismo en comparación con los CDT (66,7% frente a 25,0%, p = 0,041). Diez centros (41,7%) informaron del uso de una guía de manejo de LCT, y 15 (62,5%) implementaron protocolos de TC. Diez CDT informaron de la implementación de estrategias de intervención para la sospecha de presión intracraneal elevada (PIC) antes de realizar una TC, y 6 CNT también siguieron esta práctica (83,3% vs 50,0%, p = 0,083). El manejo en urgencias de los niños con TCE fue comparable entre los CTD y los CTN en los siguientes aspectos: neuroimagen, manejo de las vías respiratorias, monitorización de la PIC, reanimación con líquidos, tratamiento anticoagulante y control de la glucosa sérica. La terapia de hiperventilación para la PIC elevada se utilizó en el 33,3% de los centros. CONCLUSIONES Este estudio evaluó el manejo y la infraestructura de la LCT pediátrica entre 24 centros. Se observaron diferencias limitadas en la atención prehospitalaria y el manejo en urgencias de los pacientes pediátricos con LCT entre los centros de atención primaria y los centros de atención especializada. Tanto los CTD como los CNT mostraron variaciones en la implementación de las directrices actuales de manejo de la LCT. Existe una necesidad urgente de investigar las barreras específicas para la implementación de directrices en estas regiones. AANS 2023.

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OBJECTIVE There is a paucity of information on pediatric traumatic brain injury (TBI) care in Asia and Latin America. In this study, the authors aimed to describe the clinical practices of emergency departments (EDs) participating in the Saline in Asia and Latin-America Neurotrauma in the Young (SALTY) study, by comparing designated trauma centers (DTCs) and nontrauma centers (NTCs) in their networks. METHODS The authors performed a site survey study on pediatric TBI management in the EDs in 14 countries. Two European centers joined other participating sites in Asia and Latin America. Questions were formulated after a critical review of current TBI guidelines and published surveys. The authors performed a descriptive analysis and stratified centers based on DTC status. RESULTS Of 24 responding centers (70.6%), 50.0% were DTCs, 70.8% had academic affiliations, and all centers were in urban settings. Patients were predominantly transferred to DTCs by centralized prehospital services compared to those sent to NTCs (83.3% vs 41.7%, p = 0.035). More NTCs received a majority of their patients directly from the trauma scene compared to DTCs (66.7% vs 25.0%, p = 0.041). Ten centers (41.7%) reported the use of a TBI management guideline, and 15 (62.5%) implemented CT protocols. Ten DTCs reported implementation of intervention strategies for suspected raised intracranial pressure (ICP) before conducting a CT scan, and 6 NTCs also followed this practice (83.3% vs 50.0%, p = 0.083). ED management for children with TBI was comparable between DTCs and NTCs in the following aspects: neuroimaging, airway management, ICP monitoring, fluid resuscitation, anticoagulant therapy, and serum glucose control. Hyperventilation therapy for raised ICP was used by 33.3% of sites. CONCLUSIONS This study evaluated pediatric TBI management and infrastructure among 24 centers. Limited differences in prehospital care and ED management for pediatric patients with TBI were observed between DTCs and NTCs. Both DTCs and NTCs showed variation in the implementation of current TBI management guidelines. There is an urgent need to investigate specific barriers to guideline implementation in these regions. © AANS 2023.

Palabras clave

Asia, Servicio de urgencias, Directrices, América Latina, Pediatría, Prehospitalario, Traumatismo craneoencefálico

Keywords

Asia, Emergency department, Guideline, Latin America, Pediatric, Prehospital, Traumatic brain injury

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