Improving the outcome of severely head injured children in the UK

Traumatic brain injury (TBI) causes significant morbidity and mortality in children. After the primary injury, subsequent physiological insults worsen morbidity and mortality and are particularly common in the pre-hospital setting. Management of severe TBI in hospital is largely focused on the prevention of secondary brain injury, the management of raised intracranial pressure and preservation of cerebral perfusion. Large potential improvements in outcomes for severely brain injured children are possible if the child's entire NHS journey is appreciated. The first hour of this journey is spent outside of hospital where neuroprotection is not provided. Taking clinical expertise to the child, to start neuroprotection shortly after their injury and transfer them directly to definitive care, offers potential to significantly improve outcomes. This could be achieved across the nation by doctor led pre-hospital critical care teams.