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Which management strategy do parents prefer for their head-injured child: immediate computed tomography scan or
Anna Karpas1, Marsha Finkelstein, Samuel Reid
1Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, St Paul, Minneapolis 55102, USA.
Insights
Parents are divided on preferred head injury evaluation for children. A slight majority chose observation over immediate computed tomography (CT) scans, citing concerns about radiation and unnecessary testing.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Patient Decision-Making
Background:
- Head injuries in children require careful evaluation.
- Computed tomography (CT) and observation are two common management strategies.
- Parental preferences can influence healthcare decisions.
Purpose of the Study:
- To determine parental preference for immediate CT versus observation for pediatric head injuries.
- To identify factors influencing these parental preferences.
Main Methods:
- Parents of head-injured children (≥2 years) in a pediatric ED were surveyed.
- Educational materials on CT and observation were provided prior to physician assessment.
- Surveys captured preferences, reasons, injury details, and demographics.
Main Results:
- 57% of parents preferred observation; 40% preferred immediate CT.
- Reasons for CT preference: ensuring no bleeding.
- Reasons for observation preference: avoiding unnecessary tests, radiation concerns.
Conclusions:
- Parental preferences for head injury evaluation are divided.
- A small majority of parents favored observation over immediate CT scans.
- Factors like injury mechanism or demographics did not significantly influence preference.
Objective:
The objectives of this study were to determine which method of head injury evaluation, immediate computed tomography (CT) or observation, parents would prefer for their child when given the opportunity to make an informed decision and to determine factors influencing preference.
Methods:
Parents of head-injured children 2 years or older who presented to a pediatric emergency department were eligible. After triage evaluation, and before physician assessment, research assistants presented educational materials regarding the method, risks, and benefits of both immediate CT and observation. Parents then completed a survey asking them their preference, reasons for preference, details of their child's injury, and demographic information.
Results:
One hundred thirty-four parents participated. After reviewing the educational materials, 53 (40%) preferred immediate CT; 77 (57%) preferred observation; 4 (3%) did not indicate a preference. Of those parents who preferred immediate CT, the leading reason given was, "I need to be 100% sure there is no bleeding in my child's brain." Of those parents who preferred observation, the 2 leading reasons given were, "I don't want my child to have a test unless he/she absolutely has to" and "I am concerned about the possibility of radiation causing a brain tumor." Injury mechanism, time between injury and presentation, time of day, child's age, worst symptom, previous CT, and demographic markers were not statistically associated with preference.
Conclusions:
When given the opportunity to make an informed decision regarding the evaluation of their head-injured child, parents were divided as to their preference. A small majority preferred observation.
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