Under-recognized or Under-reported? A Global Bibliometric Analysis (1994-2025) of Neurological Assessment in Pediatric Intensive Care Units

ABSTRACT Critically ill children admitted to pediatric intensive care units (PICUs) face significant neurological risks, but it remains unclear whether neurological assessments are adequately integrated into clinical routines. We aimed to evaluate the global scientific landscape regarding neurological examination in PICU, combining bibliometric analysis with clinical-guided critical analysis. A comprehensive search was conducted on the Web of Science Core Collection (WoS-CC) using terms related to pediatric critical care and neurological evaluation. Eligible publications were original research articles approaching neurological assessment during PICU stay. Bibliometric indicators, science mapping, and study design profiling were analyzed. In a separate, clinically guided interpretative layer, reporting patterns related to timing, tools, and strategies of neurological assessment were synthesized. From 359 records, 128 articles met inclusion criteria. The United States accounted for over half of the publications, while most studies employed retrospective designs and focused on traumatic brain injury or cardiac arrest. Despite the relevance of clinical neurological examination – especially using the Glasgow Coma Scale (GCS) and Pediatric Cerebral Performance Category (PCPC), advanced neuromonitoring tools, e.g., EEG, intracranial pressure monitoring, and biomarkers were inconsistently applied. Notably, neurological evaluations were often underreported at admission and discharge and rarely extended to non-neurological PICU conditions. Our findings reveal a critical gap between the neurological vulnerability of PICU patients, and the limited, inconsistent assessment strategies reported in the literature. Expanding structured neurological evaluation to all critically ill children, not only those with overt neurological diagnoses, seems essential to promote brain health and long-term recovery.