Targeted Temperature Management in Pediatric Traumatic Brain Injury: A Systematic Review and Network Meta-Analysis

• Published in: World neurosurgery Vol. 173; pp. 158 - 166.e2
• Main Authors: Utsumi, Shu, Amagasa, Shunsuke, Yasuda, Hideto, Oishi, Takatoshi, Kashiura, Masahiro, Moriya, Takashi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2023
• Subjects: Arrhythmias, Cardiac; Body Temperature; Brain Injuries, Traumatic - therapy; Child; Humans; Hypothermia; Hypothermia, Induced; Network Meta-Analysis; Neurological outcome; Pediatrics; Targeted temperature management; Therapeutic hypothermia; Traumatic brain injury; RR; Pediatrics; RCT; Traumatic brain injury; NMA; CI; Therapeutic hypothermia; TBI; TTM; Neurological outcome; Targeted temperature management
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2023.01.056

The efficacy of targeted temperature management, including the appropriate length of time, in pediatric traumatic brain injury is inconclusive. We aimed to compare the efficacy of normothermia and therapeutic hypothermia administered for various durations.
We searched four databases without language limitations until December 2021 and included peer-reviewed published randomized controlled trials comparing normothermia (>35.1°C) with therapeutic hypothermia (32°C –35°C) in children aged <18 years with an acute closed severe head injury (Glasgow Coma Scale < 8) requiring hospitalization. A favorable neurological outcome was the primary outcome; secondary outcomes were mortality and arrhythmia. Two reviewers performed screening, extracted data, and assessed the risk of bias. Network meta-analysis was performed using the Grading of Recommendations, Assessment, Development, and Evaluation working group approach.
We included six trials comprising 448 children. No significant difference was observed in favorable neurological outcomes between normothermia and hypothermia at 24, 48, and 72 h (relative risk, 1.05 [95% confidence interval 0.72–1.54]); 1.14 [0.82–1.57]), and 1.19 [0.77–1.85], respectively). Mortality did not differ significantly between normothermia and hypothermia at 24, 48, and 72 hours (0.56 [0.06–5.44]), (0.63 [0.12–3.36]), and 0.90 [0.10–8.18], respectively). Arrhythmias did not differ significantly between normothermia and hypothermia at 24, 48, and 72 h (0.92 [0.01–14.58], 0.36 [0.09–1.45), and 0.95 [0.03–29.92], respectively).
No conclusive evidence was found on optimal temperature management for pediatric traumatic brain injury. A large randomized controlled trial that considers the temperature control enforcement duration is required.