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Improving the treatment of traumatic brain injuries

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Around 35,000 children in the UK are admitted to hospital each year because of a head injury.1,2 They can have many causes, including road traffic accidents or falls – and fortunately, most are not serious. But around 2,000 of these children will be left with a serious traumatic brain injury (TBI) that can have devastating, lifelong consequences – and sadly, some will even lose their lives.1 Dr Shruti Agrawal at Cambridge University Hospitals NHS Foundation Trust is aiming to improve the treatment of children with severe TBI using advanced brain monitoring techniques in a study called STARSHIP (Studying Trends of Auto-Regulation in Severe Head Injury in Paediatrics). She is hoping to develop new recommendations for how doctors manage serious brain injuries in children in the future, reducing the risk of long-term complications.

Action Medical Research and The Addenbrooke's Charitable Trust are together funding this award

How are children’s lives affected now?

Thankfully, the majority children who experience a bump or knock to their head will have no lasting effects. But sometimes it can change lives forever, with devastating and lifelong consequences for both the child and their family.

The effects of a severe traumatic brain injury (TBI) on a child will depend on its type, location, and severity. Sadly, some children will have lasting brain damage that leaves them with long-term problems including learning disabilities, emotional and behavioural issues – or they can even die.

“Each child with a severe TBI will experience a unique combination of symptoms, which can significantly impact on many aspects of their daily lives, education and social relationships,” says Dr Agrawal. “And often, it can take months or years for the full effects of the injury to become obvious.”

 “While we know how to most effectively manage severe traumatic brain injuries in adults, there is limited experience in children,” says Dr Agrawal.

How could this research help?

“Our aim is to use advanced brain monitoring techniques to improve the treatment of children with severe TBI, helping to reduce further injury and long-term complications,” says Dr Agrawal.

When treating patients with severe TBI, doctors regularly monitor blood and brain pressures to guide management. They can use these pressure readings to work out the state of blood flow regulation through advanced monitoring.

“While there is experience of this in adult’s with TBI, we don’t know yet enough about pressure patterns in children’s brains,” says Dr Agrawal

To address this, the researchers will monitor pressure readings in 135 children with severe TBI in paediatric intensive care, comparing these data with their clinical outcomes up to a year after their injury.

“We want to determine the most effective pressure and monitoring measures to limit further brain damage in children with severe TBI,” says Dr Agrawal.


  1. Trefan L, et al. Epidemiology of children with head injury: a national overview. Archives of Diseases in Childhood 2016;
  2. NHS England: NHS standard contract for paediatric neurosciences: Neurorehabilitation Section B Part 1 E09/S/d:




Project LeaderDr Shruti Agrawal, MD FRCPCH FFICM
Project TeamProfessor Peter JA Hutchison, MBBS FRCS PhDMr Matthew Garnett, BM BCh MA DM FRCS(Neurosurg)Dr Ricardo G Branco, MD PhDMr Adam Young, MBBChir MRCSProfessor Marek Czosnyka, PhDDr Peter Smielewski, PhDDr Anna Maw. MRCPCHMs Helen Fernandes, MBBS FRCS(SN) MD
Project LocationPaediatric Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge
Project Location OtherDepartment of Clinical Neuroscience, Brain Physics Laboratory, Division of Neurosurgery, University of CambridgeDepartment of Paediatric Neurology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge
Project durationThree years
Date awarded11 December 2017
Project start date1 July 2018
Project end date30 June 2022
Grant amount£147,357
Grant codeGN2609

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