Published online: 5 September 2001 © Springer-Verlag 2001 The first ever international consen- sus conference on the management of severe head injuries in children was held on 10–13 May 2001 in As- sisi, Italy and was organized by Pro- fessors Concezio Di Rocco, Maurice Choux and F. Velardi. Participants from around the world represented the fields of pediatric neurosurgery, intensive care pediatrics, basic sci- ences, and engineering/public health. The conference should be considered as an experience and a first pass at a process that will eventually lead to improvements in the management, and hopefully the outcome, of chil- dren with severe head injuries. The conference resulted in the de- fining of areas in which we should be working together with the aim of coming to a consensus about the treatment of these children and of defining areas in which further sci- and arterial line placed for ICU man- agement. Dr. Thomas Luerssen evaluated the validity of the adult guidelines as presented in the Guidelines for the Management of Severe Head Injury produced as a function of Brain Trauma Foundation and the Joint Section on Neurotrauma and Critical Care of the AANS and CNS [1]. While there is too little literature concerned specifically with children to allow recommendation of any form of treatment with strong evi- dential support, it is not contested that the three forms of therapy rec- ommended for adults with support from guidelines are also applicable in children. These three accepted therapies are drainage of CSF if a ventricular drain is available, mild hyperventilation with the PCO 2 managed so that it does not fall be- low 30 mmHg, and the use of bolus- es of mannitol to keep the serum os- molality from exceeding 320 mos- mol. Dr. Luerssen’s presentation em- phasized the lack of universal accep- tance of the findings of the Guide- lines among neurosurgeons in the United States and the near-total lack of published information regarding published data on the applicability of these guidelines to pediatric head in- jury. A significant percentage of the total time available for the confer- ence was devoted to the application of so-called second-tier therapies. Child’s Nerv Syst (2001) 17:632–634 DOI 10.1007/s003810100487 SPECIAL EVENTS Harold L. Rekate Head injuries: management of primary injuries and prevention of secondary damage A consensus conference on pediatric neurosurgery This consensus conference was organized by C. Di Rocco, M. Choux, and F. Velardi H.L. Rekate ( ✉ ) Division of Neurological Surgery, Barrow Neurological Institute, 2910 North Third Avenue, Phoenix, AZ 85013-4473, USA e-mail: harold.rekate@bnaneuro.net Fax: +1-602-4066126 entific information is necessary be- fore anything approaching a consen- sus can be reached. There was an ini- tial discussion of the ways in which public officials and manufacturers might work together to decrease the number and severity of pediatric head injuries, ranging from automo- bile and helmet design to public awareness campaigns relating to the prevention of head injuries in chil- dren. Such programs have already led to a significant decline in the number of severe head injuries re- sulting from road traffic accidents. Unfortunately, the number and se- verity of the number one mechanism in small children, i.e., falls, are less affected by such programs. The initial resuscitation in the field, emergency department, and in- tensive care unit follows well-estab- lished guidelines. Data were present- ed that indicated that the complica- tion rate for the intubation of chil- dren by qualified emergency medical technicians or in an emergency room setting was low, and therefore the threshold for intubating a severely injured child should be low. In se- verely head-injured children, intra- cranial pressure (ICP) monitoring should be instituted; the majority of participants prefer the use of intra- ventricular catheters if possible, so that CSF drainage could also be used to lower ICP. These severely injured children should have a large-bore in- travenous, central venous catheter