Implementation of a Code Intracranial Emergency (CIE) protocol significantly reduced response time to OR arrival for pediatric patients suffering from intracranial tumor and ICH emergencies.
The CIE protocol significantly reduced consultation to OR arrival time across all tumor patients.
For urgent/emergent tumor-related cases specifically, the protocol produced significant improvements in consultation to OR arrival time.
For urgent intracranial hemorrhage (ICH) cases, the protocol significantly reduced consultation to OR time and lowered average ED to initial imaging time.
The CIE protocol is a multidisciplinary activation protocol developed in 2021 with structured workflows and communication tools for non-traumatic intracranial emergencies in children.
The study was underpowered due to sample size limitations, but still demonstrated statistically significant improvements in key time intervals.
Time intervals measured included ED to initial imaging, time to initial neurosurgery consultation, time to OR arrival, and total length of hospital stay.
This research suggests that having a dedicated emergency protocol for children with brain tumors or bleeding in the brain can meaningfully speed up how quickly they receive urgent surgical care. Researchers at a large children's hospital in Chicago compared 64 pediatric patients treated before and after a new protocol — called Code Intracranial Emergency (CIE) — was introduced in 2021. The protocol brought together multiple medical teams with clearly defined roles, scripted communication, and coordinated steps, similar to the kind of rapid-response systems already used for trauma and stroke. Before the protocol existed, there was no standardized process for these types of brain emergencies in children. The study found that after the protocol was implemented, the time from when a neurosurgeon was consulted to when the patient arrived in the operating room was significantly shorter — both for brain tumor patients overall and especially for those with the most urgent tumor cases. For children with non-traumatic brain bleeding, the protocol also shortened the time from consultation to surgery, and reduced the average time from arriving in the emergency department to getting a first brain scan (from about 71 minutes down to 56 minutes). These improvements in speed of care occurred even though the study group was relatively small. This research suggests that structured, multidisciplinary emergency protocols can reduce delays in care for children facing life-threatening brain emergencies, even in settings that already have experienced medical teams. The authors note that while this study involved a limited number of patients, the results highlight the potential value of implementing similar activation protocols at other pediatric centers where no such system currently exists.
Jain R, Najem H, Mukherjee S, Votoupal M, Leonard K, Martorana J, et al.. (2026). A clinical activation protocol improves response time to urgent/emergent neurosurgical care in children with brain tumors and intracranial hemorrhage.. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. https://doi.org/10.1007/s00381-026-07436-0