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Präklinische Versorgung von Schädel-Hirn-Traumen bei Kindern

Prehospital care of pediatric traumatic brain injury

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Zusammenfassung

Hintergrund

Schädel-Hirn-Traumen (SHT) bei Kindern und Jugendlichen sind mit einer signifikanten Morbidität und bei schwerem SHT auch Mortalität vergesellschaftet. Das Ziel der Arbeit ist es, einen Überblick über das Spektrum des SHT, die Pathophysiologie und aktuelle Behandlungsempfehlungen für das präklinische Management von Kinder und Jugendliche zu geben.

Material und Methoden

Aktueller Literaturreview von Studien zum Management des SHT bei Kindern und Jugendlichen.

Ergebnisse

In den letzten Jahren wurde eine Vielzahl von Studien publiziert, die auf wissenschaftlicher Datenlage basierend die Primärversorgung von Kindern mit SHT strukturieren. Ziel ist es, unmittelbar am Unfallort anhand des klinischen Befunds und des Unfallmechanismus eine Einschätzung über den Schweregrad des SHT zu treffen und durch gezielte Maßnahmen zur Vermeidung von Hypoxie, Hypotension und Hypothermie Sekundärschäden zu minimieren. Nicht nur der Erstversorgung, sondern der zügigen Verlegung von Kindern mit schwerem SHT in Zentren mit hoher neurochirurgischer, kinderchirurgischer und pädiatrisch intensivmedizinischer Expertise kommt eine besondere Bedeutung zu, um eine Verbesserung des Überlebens und ein verbessertes neurologisches Outcome nach schwerem SHT zu erreichen.

Diskussion

Ein strukturiertes prähospitales Management kann zu einer Verringerung von sekundärer Hirnschäden nach SHT beitragen und zu einer Verbesserung des klinischen Outcomes führen.

Abstract

Background

Traumatic brain injury (TBI) in children and adolescents is associated with significant morbidity and, in severe TBI, mortality. The aim of this article is to provide an overview of the spectrum of TBI, its pathophysiology, and current treatment recommendations for prehospital management of children and adolescents with TBI.

Materials and methods

The current literature was reviewed for studies on the management of TBI in children and adolescents.

Results

In recent years, a large number of scientific studies have been published that have resulted in evidence-based guidelines for primary care of children with TBI. The primary aim is to minimize secondary brain damage following TBI, for which immediate assessment of the severity of TBI at the scene based on clinical findings and the accident mechanism and initiation of specific treatment measures to prevent hypoxia, hypotension, and hypothermia are critical. Not only prehospital management, but also the rapid transfer of children with severe TBI to centers with high neurosurgical, pediatric surgical, and pediatric intensive care expertise is of particular importance to improve survival and neurological outcome after severe TBI.

Conclusion

Structured prehospital management may help reduce secondary brain injury after TBI and lead to improved clinical outcomes.

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  1. Klinik für Neurochirurgie, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Deutschland

    Rüdiger Gerlach

  2. Klinik für Kinderchirurgie und Kinderurologie, Helios Klinikum Erfurt, Erfurt, Deutschland

    Wolfram Kluwe Dr. med.

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Correspondence to Rüdiger Gerlach.

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Gerlach, R., Kluwe, W. Präklinische Versorgung von Schädel-Hirn-Traumen bei Kindern. Med Klin Intensivmed Notfmed 118, 626–637 (2023). https://doi.org/10.1007/s00063-023-01046-3

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