Management Strategies for Severe Closed Head Injuries in Children

Brain injuries represent the most common cause of mortality and long-term morbidity from trauma in children. The management of closed head injuries focuses on prevention of secondary injury by optimizing the delivery of oxygen and nutrients to the injured brain while minimizing neuronal metabolic demand. Despite the known differences between the immature and mature brain, treatments used in head-injured children are mainly extrapolated from those employed in adults due to the paucity of class one and two studies focused on the pediatric age group. Therapies intended to minimize secondary brain injury, such as cerebrospinal fluid drainage, hypertonic saline infusion, barbiturate coma induction, brain cooling, and decompressive craniectomy, vary widely in their clinical application among practitioners and trauma centers and have unclear indications, benefits, and long-term consequences. Prospective studies on brain injury management in children are needed to develop treatment strategies that optimize outcomes.