Effectiveness of the head CT choice decision aid in parents of children with minor head trauma: study protocol for a
Erik P Hess1, Kirk D Wyatt, Anupam B Kharbanda
1Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, 55905 Rochester, MN, USA. hess.erik@mayo.edu.
Insights
A new decision aid helps parents of children with head trauma make informed choices about cranial CT scans, reducing radiation exposure risks. This study evaluates its effectiveness in shared decision-making and healthcare outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Decision-Making
- Radiology Safety
Background:
- Blunt head trauma is a significant cause of pediatric mortality and morbidity globally.
- Cranial computed tomography (CT) is standard for diagnosing traumatic brain injury (TBI) but involves ionizing radiation, a risk factor for childhood cancers.
- Developing tools to support shared decision-making is crucial for optimizing care in pediatric head trauma.
Purpose of the Study:
- To develop and test the effectiveness of a decision aid, 'Head CT Choice', for parents of children with blunt head trauma.
- To facilitate shared decision-making regarding cranial CT scans versus observation.
- To evaluate the impact on parent knowledge, engagement, and healthcare utilization.
Main Methods:
- A multicenter, clinician-level, parallel randomized trial involving five diverse emergency departments.
- Clinicians randomized to either the 'Head CT Choice' decision aid or usual care.
- Enrollment of children under 18 with blunt head trauma and 1-2 risk factors for clinically-important TBI (ciTBI).
Main Results:
- The study will measure effects on parent knowledge of ciTBI risk and radiation, parent engagement, decision-related conflict, and satisfaction.
- Outcomes include the rate of ciTBI, CT scan acquisition proportion, and seven-day healthcare utilization.
- Data collection involves surveys, video recordings, diaries, billing records, EMR review, and telephone follow-up.
Conclusions:
- This trial will rigorously evaluate a decision aid's impact on patient-centered outcomes, safety, and healthcare utilization.
- The findings aim to improve the decision-making process for cranial CT scans in pediatric head trauma.
- The study addresses the critical need for evidence-based tools in pediatric emergency care.
Background:
Blunt head trauma is a common cause of death and disability in children worldwide. Cranial computed tomography (CT), the reference standard for the diagnosis of traumatic brain injury (TBI), exposes children to ionizing radiation which has been linked to the development of brain tumors, leukemia, and other cancers. We describe the methods used to develop and test the effectiveness of a decision aid to facilitate shared decision-making with parents regarding whether to obtain a head CT scan or to further observe their child at home.
Methods/Design:
This is a protocol for a multicenter clinician-level parallel randomized trial to compare an intervention group receiving a decision aid, 'Head CT Choice', to a control group receiving usual care. The trial will be conducted at five diverse emergency departments (EDs) in Minnesota and California. Clinicians will be randomized to decision aid or usual care. Parents visiting the ED with children who are less than 18-years-old, have experienced blunt head trauma within 24 hours, and have one or two risk factors for clinically-important TBI (ciTBI) from the Pediatric Emergency Care Applied Research Network head injury clinical prediction rules will be eligible for enrollment. We will measure the effect of Head CT Choice on: (1) parent knowledge regarding their child's risk of ciTBI, the available diagnostic options, and the risks of radiation exposure associated with a cranial CT scan (primary outcome); (2) parent engagement in the decision-making process; (3) the degree of conflict parents experience related to feeling uninformed; (4) patient and clinician satisfaction with the decision made; (5) the rate of ciTBI at seven days; (6) the proportion of patients in whom a cranial CT scan is obtained; and (7) seven-day healthcare utilization. To capture these outcomes, we will administer parent and clinician surveys immediately after each clinical encounter, obtain video recordings of parent-clinician discussions, administer parent healthcare utilization diaries, analyze hospital billing records, review the electronic medical record, and conduct telephone follow-up.
Discussion:
This multicenter trial will robustly assess the effectiveness of a decision aid on patient-centered outcomes, safety, and healthcare utilization in parents of children with minor head trauma in five diverse EDs.
Trial Registration:
ClinicalTrials.gov registration number: NCT02063087. Registration date February 13, 2014.
