{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T03:54:55Z","timestamp":1788666895174,"version":"build-2803163510"},"reference-count":64,"publisher":"SAGE Publications","issue":"21-22","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:p>\n                    Traumatic brain injury (TBI) is the leading cause of death and disability in children. Many clinical practice guidelines (CPGs) have addressed pediatric TBI in the last decade but significant variability in the use of these guidelines persists. Here, we systematically review CPGs recommendations for pediatric moderate-to-severe TBI, evaluate the quality of CPGs, synthesize the quality of evidence and strength of included recommendations, and identify knowledge gaps. A systematic search was conducted in MEDLINE\n                    <jats:sup>\u00ae<\/jats:sup>\n                    , Embase, Cochrane CENTRAL, Web of Science, and Web sites of organizations publishing recommendations on pediatric injury care. We included CPGs developed in high-income countries from January 2012 to May 2023, with at least one recommendation targeting pediatric (\u2264 19 years old) moderate-to-severe TBI populations. The quality of included clinical practice guidelines was assessed using the AGREE II tool. We synthesized evidence on recommendations using a matrix based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. We identified 15 CPGs of which 9 were rated moderate to high quality using AGREE II. We identified 90 recommendations, of which 40 (45%) were evidence based. Eleven of these were based on moderate to high quality evidence and were graded as moderate or strong by at least one guideline. These included transfer, imaging, intracranial pressure control, and discharge advice. We identified gaps in evidence-based recommendations for red blood cell transfusion, plasma and platelet transfusion, thromboprophylaxis, surgical antimicrobial prophylaxis, early diagnosis of hypopituitarism, and mental health mangement. Many up-to-date CPGs are available, but there is a paucity of evidence to support recommendations, highlighting the urgent need for robust clinical research in this vulnerable population. Our results may be used by clinicians to identify recommendations based on the highest level of evidence, by healthcare administrators to inform guideline implementation in clinical settings, by researchers to identify areas where robust evidence is needed, and by guideline writing groups to inform the updating of existing guidelines or the development of new ones.\n                  <\/jats:p>","DOI":"10.1089\/neu.2023.0149","type":"journal-article","created":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T05:29:30Z","timestamp":1687325370000},"page":"2270-2281","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":34,"title":["Pediatric Moderate and Severe Traumatic Brain Injury: A Systematic Review of Clinical Practice Guideline Recommendations"],"prefix":"10.1177","volume":"40","author":[{"given":"Anis","family":"Ben Abdeljelil","sequence":"first","affiliation":[{"name":"Population Health and Optimal Health Practices Research Unit, Trauma \u2013 Emergency \u2013 Critical Care Medicine, Centre de Recherche du CHU de Qu\u00e9bec \u2013 Universit\u00e9 Laval (H\u00f4pital de l'Enfant-J\u00e9sus), Quebec City, Quebec, Canada."},{"name":"Department of Social and Preventative Medicine, Universit\u00e9 Laval, Quebec City, Quebec, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle C.","family":"Freire","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of Toronto,Toronto, Ontario, Canada."},{"name":"Child Health Evaluative Sciences Program, Peter Gilgan Institute for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Yanchar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis F.","family":"Turgeon","sequence":"additional","affiliation":[{"name":"Population Health and Optimal Health Practices Research Unit, Trauma \u2013 Emergency \u2013 Critical Care Medicine, Centre de Recherche du CHU de Qu\u00e9bec \u2013 Universit\u00e9 Laval (H\u00f4pital de l'Enfant-J\u00e9sus), Quebec City, Quebec, Canada."},{"name":"Department of Social and Preventative Medicine, Universit\u00e9 Laval, Quebec City, Quebec, Canada."},{"name":"Department of Anesthesiology and Critical Care Medicine, Universit\u00e9 Laval, Quebec City, Quebec, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Beno","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"B\u00e9rub\u00e9","sequence":"additional","affiliation":[{"name":"Population Health and Optimal Health Practices Research Unit, Trauma \u2013 Emergency \u2013 Critical Care Medicine, Centre de Recherche du CHU de Qu\u00e9bec \u2013 Universit\u00e9 Laval (H\u00f4pital de l'Enfant-J\u00e9sus), Quebec City, Quebec, Canada."},{"name":"Department of Faculty of Nursing, Universit\u00e9 Laval, Quebec City, Quebec, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Stang","sequence":"additional","affiliation":[{"name":"Pediatrics, Emergency Medicine, and Community Health Sciences, Cumming School of Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Stelfox","sequence":"additional","affiliation":[{"name":"Departments of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Zemek","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Beaulieu","sequence":"additional","affiliation":[{"name":"Department of Department of Pediatrics, Universit\u00e9 Laval, Quebec City, Quebec, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle J.","family":"Gagnon","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, McGill University Health Centre, Montreal Children's Hospital, Montreal, Quebec, Canada."},{"name":"School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belinda","family":"Gabbe","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francois","family":"Lauzier","sequence":"additional","affiliation":[{"name":"Population Health and Optimal Health Practices Research Unit, Trauma \u2013 Emergency \u2013 Critical Care Medicine, Centre de Recherche du CHU de Qu\u00e9bec \u2013 Universit\u00e9 Laval (H\u00f4pital de l'Enfant-J\u00e9sus), Quebec City, Quebec, Canada."},{"name":"Department of Social and Preventative Medicine, Universit\u00e9 Laval, Quebec City, Quebec, Canada."},{"name":"Department of Anesthesiology and Critical 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