Clinical practice guidelines for moderate to severe paediatric traumatic brain injury in Australasia: A scoping review.

BACKGROUND: Acute moderate-to-severe traumatic brain injury (TBI) is a major cause of trauma-related morbidity and mortality among children in Australasia. Although the PREDICT guideline provides consensus recommendations for mild to moderate paediatric TBI management in Australasia, no equivalent regional consensus guideline exists for moderate to severe injury. Existing Australasian guidelines for this population have also not been systematically appraised for quality. OBJECTIVES: This scoping review aimed to (1) systematically identify moderate to severe paediatric TBI guidelines in Australia and New Zealand; (2) extract key themes in acute management; and (3) appraise guideline quality using the AGREE-II tool. METHODS: A comprehensive search of Medline, Embase, PubMed, Cochrane CENTRAL, and grey literature was conducted. Two reviewers independently completed screening, data extraction, and AGREE-II scoring. Inter-rater reliability was assessed using intraclass correlation coefficients (ICC). RESULTS: Of 866 screened articles, nine guidelines were included in the final review. Assessment/Triage and diagnostic imaging were the most frequently addressed management themes. The PREDICT guideline was the only high-quality guideline. Hospital-based guidelines were generally rated low quality, particularly for methodological rigour. Reviewer and Inter-rater agreement was high (ICC > 0.7). CONCLUSIONS: The PREDICT guideline demonstrated the strongest methodological quality, while hospital-based guidelines prioritised applicability but often lacked transparent development methods. Improved documentation of evidence selection and recommendation development is needed to enhance guideline, credibility and uptake across Australasian clinical settings.