Management of Paediatric Head Injuries in Sweden: A 5 National Cross-Sectional Survey

Abstract

Background Previous studies have shown varying management of children with traumatic brain injury (TBI) in Sweden. Recently, new guidelines have been introduced which may have affected management of these patients. Methods Cross-sectional structured survey, containing different management domains, in Sweden during 2020, using an on-line survey system aiming to describe initial (first 24 hours) management of TBI in children. Data presented as descriptive analysis and comparisons with Fisher exact test when applicable. Results 56 hospitals of differing size were included in the analysis (response rate 93%). 76% used established guidelines. Children with TBI are predominately managed by inexperienced doctors (84%), primarily from non-paediatric specialities (75%). Most hospitals (75%) have the possibility to observe children with TBI and almost all have complete access to CT scans. In larger hospitals, it was more common for nurses to discharge patients without doctor assessment (p<0.001). Use of established guidelines and written observation routines has increased significantly since 2006 (p<0.001). Conclusions Management of children with TBI still varies in Sweden, although many aspects have significantly improved over the last 15 years. Most hospitals use established guidelines, utilise dose-reduction protocols for CT, use written observation routines and provide adequate information to patients/guardians at discharge.