Introduction: Trauma is the leading cause of death in children. Nearly 50% of all pediatrics trauma involves head injury. Objective: To determine what policies and methods Canadian Pediatric Intensive Care Unit(PICU) physicians and neurosurgeons use in caring for the child with head injury. Methods: A 23 item questionnaire was sent to 54 pediatric intensivists and neurosurgeons in 16 centres across Canada (with one in Florida). The questionnaire included items regarding hyperventilation, body positioning, sedation, drug therapy and monitoring. A table incorporating therapies indexed to the Glasgow Coma Scale was used to compare the protocols of participating centres. Three questions were asked regarding whether an established head injury protocol was in place. Results: We received 41 completed questionnaires from 15 centres. 33 respondents were pediatric intensivists (80.5%), 7 were anaesthesiologists (17.1%) and 1 was a neurosurgeon (2.4%). The majority of respondents had worked in the PICU less than 5 years, with a mean of 10 to 15 years. Only 2 respondents said that they did not hyperventilate for head injury; both disagreed with other physicians from their own centre. When asked to define hyperventilation, 14 respondents said PaCO2<30 (34.1%) and 27 said PaCO2<35 (65.9%); in addition there were five centres whose physicians disagreed over this issue (33.3%). Of the 39 respondents who hyperventilated for head injury, 21 said they insist on an ICP monitor (53.8%). 35 respondents in 14 centres were uncertain about the benefits of hyperventilation (85.4%). 25 respondents in 11 centres said they had an agreed upon head injury protocol. Despite this, there were 5 intra-centre disagreements of the 10 centres that had more than one respondent. Conclusions: There is extensive disagreement in the care and treatment of the head injured child in Canada. Where hyperventilation is used, there is still disagreement, even within units, about what it is or how to use it properly. Importantly, most PICU physicians are uncertain regarding the benefits of hyperventilation. A multicentre, randomized, controlled trial of hyperventilation is necessary to determine its benefits.
