Traumatic Brain Injury in the Pediatric Population: Challenges in Emergency Care

Dear Editor, Children present with a range of conditions seeking emergency medical care, ranging from trivial injuries to life-threatening and fatal injuries.1,2 Trauma is a significant cause of morbidity and mortality in children worldwide.3 Traumatic brain injury is among the most important causes, which may be due to accidents or child abuse. Although highlighted many times, there is a continued need for research identifying the burden and challenges to manage pediatric neurotrauma and thus to improve outcomes in low- and middle-income countries.4 The research needs to focus on developing comprehensive mechanisms to identify and manage pediatric traumatic brain injuries in the prehospital setting, emergency room, in the hospital, and postdischarge care.5 Patients should have timely access to various facilities and personnel, an appropriate duration of stay in the emergency department (ED) to optimize resource utilization, and effective patient care.6 It is very important to identify what patients should expect from an ED, including the right personnel, environment, decision-making, processes, approach, and support.6 The suggested strategies to improve performance in pediatric emergency care include time to diagnosis and time, ED length of stay/wait time, correct diagnosis and appropriate treatment, overall workload ED returns, left without being seen, mortality, patient satisfaction, rate of complaints, provider satisfaction, and staff safety.7 It cannot be overstated that the best strategy would be to focus on educating and informing about injury prevention methods.4 However, given ongoing advancements, increased mobility, and ever-increasing transport methods, there is an expected need for low-cost targeted interventions to guide the provision of timely trauma care and early interventions, thereby improving outcomes in low- and middle-income countries.8 Future studies need to focus on analyzing the strengths and lacunae in trauma systems in emergency rooms, including outcomes, differences in patient populations, their physiologic and injury characteristics, adjustments by income groups, and resource availability.8 The objectives can potentially be achieved through specific protocols largely based on evidence-based practices and local needs. A mechanism should be in place to monitor performance, deficiencies, and lapses, evaluate targeted interventions, and provide feedback to enhance the efficiency of ongoing processes. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.