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Emergency Department Care of Young Children with Traumatic Brain Injury: What are We Doing and Do Parents Understand?

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Emergency Department Care of Young Children with Traumatic Brain Injury: What are We Doing and Do Parents Understand?
Caroline Reilly, BS and Tara Rhine, MD, MS, Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, Cincinnati OH

Background: Given the long-term risks associated with computed tomography (CT), a validated clinical decision rule has been implemented to identify children for whom a period of observation is a feasible alternative to CT following head trauma. Methods: This was an observational study evaluating emergency department (ED) management of children <5 years old who presented within 6 hours of head injury. Children were eligible if a period of observation was an appropriate ED management option based on the decision rule. Demographic variables and ED care practices were collected. Parents were subsequently contacted to assess understanding of ED management and satisfaction with care. Results and Conclusion Thirty children (60% male) with an average age of 16.6 (±14.4) months were enrolled. Thirteen children received a head CT and 20 were observed per physician report, with a length of stay of 2.71 (±1.53) hours. Twenty-five (83%) parents completed follow-up, and while 16 had been observed, only 5 reported that this occurred in the ED. Despite this finding, based on a Likert scale of 1-10, the average parental satisfaction score for parent-physician communication was 8.4 (±2.2). Parental comfort level with getting a CT is in Table 1. Findings suggest that imaging rates remain high, even among children observed. Moreover, parents are often unaware of clinical observation when it does occur. Better physician-parent communication could improve parental understanding and reduce discomfort.

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Objective: To understand emergency department management of young children with traumatic brain injury and describe parental perceptions of care received.

Objective Content: To further understanding on how to implement evidence-based care that utilizes an observation period and reduces unnecessary CTs in young children with traumatic brain injuries. Additionally, to identify deficiencies in physician-parent communication in the ED and use this information to educate ED providers and improve future care for this population.


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