Background Traumatic brain injury (TBI) in children is a leading cause of disability and death worldwide (1). Prehospital care plays a vital role in improving outcomes for paediatric TBI patients (2-5). However, the accuracy of paediatric TBI triage tools can be influenced by various factors. This systematic review aimed to assess the agreement between paramedics and emergency department (ED) physicians regarding the reliability of paediatric TBI identification tools and the diagnostic accuracy of these tools in prehospital settings.

Methods MEDLINE (OVID), EMBASE (OVID), Cochrane Library (OVID), and CINAHL Plus (EBSCO) databases were searched from inception to October 27, 2022, including English-language studies. Quality assessment was conducted using COSMIN for interobserver reliability studies and the modified QUADAS-2 tool for diagnostic accuracy studies. A narrative synthesis approach was employed due to the unsuitability of meta-analysis.

Results Out of 660 papers identified, only five studies met the inclusion criteria, three focusing on interobserver reliability and two on diagnostic accuracy. Moderate agreement was found between paramedics and ED physicians in assessing the Glasgow Coma Scale (GCS). Diagnostic accuracy studies examined various triage tools, including the paediatric trauma score (PTS), paediatric triage tape (PTT), and pre-hospital GCS. These tools demonstrated suboptimal diagnostic accuracy, suggesting potential harm to patients. Urgent attention is needed to improve diagnosis accuracy and prehospital management.

Conclusion This review highlights a lack of consensus between paramedics and ED physicians in assessing paediatric TBI using triage tools. The low accuracy in diagnosing paediatric TBI raises concerns about patient harm. Improving diagnostic accuracy and prehospital management should be prioritized. Further research is required to identify underlying causes and develop effective solutions to ensure timely and appropriate care for paediatric TBI patients.