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Nurse-Driven Electronic Medical Record Based Concussion Screening Improves Identification And Intervention In Pediatric Traumatic Brain Injury - A Quality Improvement Initiative
*Katie Downie1, *Aaron J Cunningham2, *Mubeen Jafri1
1Randall Children's Hospital at Legacy Emanuel Medical Center, Portland, OR;2Oregon Health & Science University, Portland, OR

Purpose: We implemented a screening tool to identify risk for concussion to improve access to cognitive evaluation and intervention in injured children.
Relevance/Significance: Mild traumatic brain injury (TBI) may be difficult to identify in injured children. Prior to implementation of our screening tool, children admitted without obvious head injury or those less than 12 were not being screened for concussion risk.
Strategy and Implementation: We employed a nurse-driven concussion screening tool derived from the Centers for Disease Control and Prevention, Acute Concussion Evaluation (ACE) on all pediatric trauma patients ages 0-17 years old. The screening tool identifies symptoms of physical, cognitive, sleep or emotional deficits and prompts a cognitive evaluation with concussion education. This was administered by nursing, tracked in the electronic medical record (EMR).
Evaluation/Outcomes: Key stakeholders were interviewed to identify workflow barriers and education gaps following implementation. Enhancements to the EMR and refocused nursing education improved compliance from 39% in the first 12 months to 88% at 20 months post implementation (p<0.01). The increasing number of evaluations additionally resulted in significantly more cognitive evaluations as an initial step in identifying and treating previously unrecognized TBI.
Implications for Practice: A pediatric concussion screening tool is simple to administer, applies to all developmental ages, and improves diagnostic capture of traumatic brain injury in pediatric trauma when administered by nurses and support through the EMR.

Screening and Cognitive Evaluations after Nurse-Driven Concussion Assessment Tool Implementation
Early Protocol Period (%)Late Protocol Period (%)p
Trauma Admissions290183
Concussion Screens114 (39.3%)161 (88.0%)<0.00001
Cognitive Evaluations25 (8.6%)43 (23.5%)0.000124


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