• Shu Utsumi, Shunsuke Amagasa, Hideto Yasuda, Takatoshi Oishi, Masahiro Kashiura, and Takashi Moriya.
• Division of Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan; Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
• World Neurosurg. 2023 May 1; 173: 158166.e2158-166.e2.

BackgroundThe 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.MethodsWe 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.ResultsWe 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).ConclusionNo 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.Copyright © 2023 Elsevier Inc. All rights reserved.

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