Association Between Adherence to Guidelines and Patient Outcomes in Severe Pediatric Traumatic Brain Injury: A Scoping Review.

Abstract

This scoping review aimed to systematically describe the literature reporting the relationship between guidelines adherence and outcomes in children with severe traumatic brain injury (TBI). The search for articles of interest was performed in the Pubmed, Embase, Cochrane Library, and Google Scholar databases. Two investigators independently screened publications from 2000 to March 2024 reporting the relationship between the implementation of a protocolized management or adherence to guidelines for severe pediatric TBI management and patient outcomes. Discrepancies regarding study eligibility were resolved by consensus, and with a third reviewer if needed. Inclusion criteria included pediatric severe TBI, reporting of clinical outcomes, with comparison of whether guidelines were respected or not. Among 2141 articles identified after the systematic search, eight articles were included in the review. The implementation of a management protocol for severe TBI was reported in five studies and was associated with a reduction in mortality and an improvement in functional prognosis. Three articles also highlighted a statistical association between adherence to guidelines and improved outcomes. In conclusion, guidelines adherence after a pediatric severe TBI was associated with improved survival and functional patient outcomes in all studies identified, although the strength of this observation is limited by the observational or pre-post design of all included studies.