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Mild traumatic brain injury in children: management practices in the acute care setting
Bridget Kool1, Vivienne King, Carol Chelimo
1Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
Insights
Accurate diagnosis and management of mild traumatic brain injury (MTBI) in children are crucial. While acute care often follows best practices, improvements in follow-up care and guideline consistency are needed for better outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Evidence-Based Healthcare
Background:
- Mild traumatic brain injury (MTBI) in children requires accurate diagnosis, treatment, and follow-up to prevent post-concussive symptoms and long-term disability.
- Clinical decision-making in pediatric MTBI assessment and management in acute care settings is critical for optimal patient outcomes.
Purpose of the Study:
- To explore clinicians' decisions in assessing and managing pediatric MTBI in acute care.
- To identify barriers and enablers to delivering best-practice care for children with MTBI.
Main Methods:
- Survey of 29 clinicians in pediatric Emergency Departments (EDs) and an Urgent Care clinic.
- Utilized a vignette-based questionnaire assessing guideline awareness, attitudes, use of decision support systems, and evidence-based practice knowledge.
Main Results:
- Acute MTBI evaluation and management generally aligned with best practices, especially for identifying surgical injuries, monitoring, pain management, and discharge advice.
- Significant variation was observed in follow-up care and referral pathways.
- Barriers included lack of guideline awareness, specific attitudes towards MTBI, and time constraints.
Conclusions:
- Opportunities exist to enhance pediatric MTBI care in acute settings.
- Recommendations include consistent, up-to-date guidelines, clearer referral/follow-up pathways, targeted medical education, and computerized decision support for systematic management.
Objective:
Accurate diagnosis, treatment and follow up of children suffering mild traumatic brain injury (MTBI) is important as post-concussive symptoms and long-term disability might occur. This research explored the decisions clinicians make in their assessment and management of children with MTBI in acute care settings, and identified barriers and enablers to the delivery of best-practice care.
Methods:
A purposeful sample of 29 clinicians employed in two metropolitan paediatric EDs and one Urgent Care clinic was surveyed using a vignette-based questionnaire that also included domains of guideline awareness, attitudes to MTBI care, use of clinical decision support systems, and knowledge and skills for practising evidence-based healthcare.
Results:
Overall, the evaluation and management of children presenting acutely with MTBI generally followed best-practice guidelines, particularly in relation to identifying intracranial injuries that might require surgical intervention, observation for potential deterioration, adequate pain management and the provision of written head injury advice on discharge. Larger variation emerged in regard to follow-up care and referral pathways. Potential barriers to best- practice were lack of guideline awareness, attitudes to MTBI, and lack of time or other priorities.
Conclusions:
Opportunities exist to improve care for children who present in acute care settings following mild traumatic brain injury. These include having up-to-date guidelines that are consistent across acute care settings; providing clearer pathways for referral and follow up; targeting continuing medical education towards potential complications; and providing computerised decision support so that assessment and management are conducted systematically.
