DMICE Faculty and Staff Co-author Evidence-based Guidelines for Severe Traumatic Brain Injury in Children

Traumatic brain injury (TBI) is a leading cause of death and disability in children and adolescents. In March 2019, the third edition of the Brain Trauma Foundation Guidelines for the Management of Pediatric Brain Injury was released, updating the 2012 edition. But people may not realize that the Pacific Northwest Evidence-based Practice Center (EPC), based in the Department of Medical Informatics and Clinical Epidemiology (DMICE), has played a major role in all three editions of the guideline.

Four authors of the newly released guidelines, published in a supplement to the March 2019 issue of Pediatric Critical Care Medicine, are investigators or staff in the Pacific Northwest EPC:  professor Nancy Carney, Ph.D., associate professor Annette Totten, Ph.D., research associate Cindy Davis-O’Reilly, and senior research assistant Erica Hart.

But the story begins 19 years ago, a few years after the EPC, then known as the Oregon EPC, was founded in 1997. In 2000, Dr. Carney, who, under the direction of now professor Mark Helfand M.D., M.P.H., M.S., had worked on our EPC’s first evidence report related to rehabilitation for TBI, assembled a team from OHSU – including Ms. Davis-O’Reilly and former faculty Drs. Hugo du Coudray and Randall Chesnut – to take on the task of producing evidence-based guidelines for brain trauma in children. Dr. Carney contacted clinicians who had participated in previous unsuccessful attempts at writing pediatric guidelines and convinced them to work with the EPC at OHSU.

Dr. Carney, armed with a comprehensive literature search produced by the EPC, assembled the group of neurosurgeons and critical care physicians at a National Brain Injury Association meeting in Chicago to initiate the project. Nathan Selden, M.D., Ph.D., now Campagna professor and chair of neurological surgery at OHSU, was a member of this first guidelines group. The first version of the guidelines was published simultaneously in three journals, Critical Care Medicine, Pediatric Critical Care Medicine, and Journal of Trauma, in special supplements in July 2003, with Drs. Carney, Selden, Chesnut, du Coudray, Brahm Goldstein, M.D., Helen Miller, M.D., and Craig Warden, M.D., M.P.H. – all from OHSU –  among the authors.

“We had the expertise of the EPC as a foundation for the work, and the tremendous commitment of the pediatric clinicians on the team who were determined to produce evidence-based treatments for children,” Dr. Carney reported. “These guidelines have inspired a new generation of strong research that will strengthen the evidence-base for future editions.”

Dr. Carney then served as principal investigator for the Brain Trauma Foundation’s multiple TBI guidelines projects from 2004 through 2012, at which time the EPC officially took over and continues to run the program, with professor Roger Chou, M.D., as principal investigator, Dr. Totten as program director, Dr. Carney on the author team, and Ms. Davis-O’Reilly and Hart as research staff. The second edition of the pediatric guidelines was published in Pediatric Critical Care Medicine in a supplement in January 2012. Drs. Carney, Selden, Chesnut, Goldstein, and Warden were co-authors, along with several EPC research associates. The fourth edition of the guidelines for severe TBI in adults, for which Drs. Carney and Totten and Ms. O’Reilly were first, second, and third authors, respectively, has been cited over 500 times since its publication in January 2017.

The EPC oversaw the work of the third edition of the pediatric guidelines, with funding from the Department of Defense via a subcontract from Stanford University. With the addition of 48 new studies since the second edition, the new guidelines provided a foundation for the concurrent development and publication of “Pediatric Severe Traumatic Brain Injury: 2019 Consensus and Guidelines-Based Algorithm for First and Second Tier Therapies.” This treatment algorithm, based on evidence from the guidelines and extended through an expert consensus process, provides a clinically useful protocol for management of these severely injured children.