The Scandinavian pediatric head injury guidelines

The Scandinavian Neurotrauma Committee (SNC) has initiated the process of updating its 2016 guidelines for the management of pediatric head injuries. The work builds on findings from the Scandinavian Head Injury Trial in Paediatric Patients Project (SHIPP), one of the largest prospective pediatric head injury cohorts worldwide.

The updated guidelines will be developed through systematic literature reviews and a formal Delphi consensus process involving experts from across Scandinavia. The aim is to provide an evidence-based framework for the assessment and management of children with head injuries, with particular emphasis on identifying those at risk of clinically important intracranial injury while avoiding unnecessary CT examinations and hospital admissions.

Alongside the guideline work, analyses of the SHIPP cohort are ongoing, including studies of long-term outcomes after pediatric head injury. Preparations are also underway for SHIPP-bio, a prospective biomarker study evaluating the role of blood biomarkers in pediatric traumatic brain injury.

By combining emerging evidence with broad clinical expertise, the updated guidelines aim to support safe and consistent care for children with head injuries across the Nordic countries.

Scandinavian guidelines for management of coagulation in traumatic brain injury

The SNC is finalizing new evidence-based guidelines for the comprehensive management of coagulation following moderate-to-severe TBI, scheduled for publication later this year. Developed through a rigorous combination of systematic literature reviews and a formal, consensus-driven Delphi process, this document provides a highly anticipated framework for acute neurocritical care. The guidelines focus on practical clinical utility, offering a clear, evidence-based summary to guide real-time decision-making in complex bleeding and clotting scenarios. By standardizing practices across Nordic centers, this landmark consensus aims to optimize patient safety, reduce clinical variability, and establish a unified standard for modern neurotrauma management.  

The FITCH-trial

Within the SNC, the planning for a neurotrauma trial proceeds. It will be one of the largest TBI trials ever, utilizing a pragmatic, multi-center, 2x2x2 factorial randomized design across all major Nordic centers. Named the FITCH trial, it evaluates optimal hemostatic strategies by investigating distinct treatment thresholds for INR, platelets, and fibrinogen in moderate-to-severe traumatic brain injury. By targeting separate physiological pathways simultaneously, this highly efficient “three-in-one” design aims to maximize study resources and establish a new evidence-based consensus. Ultimately, the trial will determine which specific coagulation targets optimize survival and functional recovery at 6 months. More to come on this trial soon…