Organizational management of moderate and severe paediatric traumatic brain injury: results from a European survey.

Introduction: Management of moderate/severe paediatric traumatic brain injury (mspTBI) varies across Europe. The decline in case numbers perceived in many regions raises concerns about maintaining high-quality, sustainable care. Research question: This study aimed to examine the organization of mspTBI management in Europe, focusing on expertise availability, guideline adherence, neuromonitoring use, and clinician's confidence in care delivery through a survey. Material and methods: A 34-question survey was distributed to European neurosurgical and intensive care communities. Only hospitals treating children with mspTBI were included. Centres were stratified by their catchment population size and their access to dedicated expertise. Results: Seventy-six institutions from 23 countries responded. Most centres reported a mspTBI case load of less than 20 children per year. Access to paediatric anesthesiology was significantly associated with centre size (p = 0.001), while access to paediatric neurosurgery, intensive or neurointensive care was not. Most centres (96 %) reported adherence to (inter)national guidelines. Intracranial pressure (78.7 %) and transcranial Doppler (70.7 %) were the most frequently available/used neuromonitoring modalities. Confidence in managing mspTBI was significantly higher in centres with paediatric neurosurgeons and, for older children, paediatric neuro-intensivists. Discussion: This first European survey examining organizational management of mspTBI reveals a low overall caseload and uneven access to paediatric expertise. Confidence in managing mspTBI correlates with availability of paediatric subspecialists. Guidelines are widely applied, independent of expert availability, but are alone insufficient to ensure treatment confidence. This finding underscores the need for improved guidelines and better access to paediatric neurotrauma expertise.