Nurse-Driven Universal Concussion Screening: A Quality Improvement Initiative.

Area of Science:

• Pediatric Trauma Care
• Neurology
• Public Health

Background:

• Mild traumatic brain injury (TBI) in children can be challenging to diagnose.
• Universal concussion screening was implemented in a pediatric trauma center.
• Previous protocols missed concussions in children without obvious head injury or under 12 years old.

Purpose of the Study:

• Evaluate a performance improvement initiative for universal pediatric concussion screening.
• Improve identification of concussion risk in pediatric trauma admissions.
• Enhance access to cognitive evaluation and intervention for pediatric concussion.

Main Methods:

• A nurse-driven screening tool, based on the CDC Acute Concussion Evaluation, was used for pediatric trauma patients (ages 0-17).
• The tool assessed physical, cognitive, sleep, and emotional deficits, prompting cognitive evaluation and education.
• Screening was administered by nurses and documented in the electronic medical record.

Main Results:

• Workflow barriers and education gaps were identified through stakeholder interviews.
• Electronic medical record enhancements and nursing education improved screening compliance from 41% to 91%.
• Increased cognitive evaluations led to better identification and treatment of unrecognized TBI.

Conclusions:

• A pediatric concussion screening tool is simple and applicable across developmental ages.
• Nurse-administered screening, supported by electronic medical records, enhances TBI diagnostic capture in pediatric trauma.
• The initiative successfully improved the identification and management of concussions in injured children.