Background: Acute moderate to severe traumatic brain injury (TBI) is a leading cause of death among children in Australasia. While PREDICT guidelines address mild to moderate TBI, no consensus guideline exists for moderate to severe paediatric TBIs, nor has there been a quality appraisal of existing guidelines in Australasia.
Aims: This project aimed to (1) identify key themes in acute management of moderate to severe paediatric TBI and (2) appraise the quality of current moderate to severe paediatric TBI guidelines in Australasia using the AGREE-II tool.
Methods: A systematic search of Medline, Embase, PubMed and Cochrane, and an advanced search in Google were conducted. Screening, full-text review, and data extraction were performed in Covidence, followed by AGREE-II quality appraisal by two independent reviewers. Reliability was assessed using intraclass correlation.
Results: The database search yielded 856 articles and 10 grey literature articles. Nine guidelines were included in the AGREE-II appraisal. The most common theme was Assessment and Triage, while the least common theme was Patient and Family Support. PREDICT was the only high-quality guideline, scoring high in all domains; all other hospital-based guidelines were of low quality, albeit scoring highly in the clarity of presentation domain. The intraclass correlation was >0.7, indicating good agreement between reviewers.
Discussion and conclusion: There needs to be a greater emphasis on patient support in guidelines to improve shared decision making. Hospital TBI guidelines are clear in presentation, but lack methodological rigour compared to PREDICT. Further research is needed on guideline implementation and variations between hospital and group-developed guidelines.