Head home: implementation during COVID-19 pandemic

Area of Science:

• Emergency Medicine
• Pediatric Traumatology
• Clinical Practice Implementation

Background:

• Previous research indicated 20-50% of pediatric head injuries could be safely discharged using the Head Injury Discharge At Triage (HIDAT) tool.
• The study aimed to integrate the HIDAT tool into routine clinical practice for pediatric head injury management.

Purpose of the Study:

• To implement and evaluate the 'Head Injury Discharge At Triage' (HIDAT) tool in a pediatric emergency department setting.
• To assess the safety and feasibility of discharging pediatric head injury patients without medical review post-triage.

Main Methods:

• Paediatric emergency department (ED) triage staff received competency-based training for the HIDAT tool.
• Data from pediatric head injury presentations between May 1 and October 31, 2020, were analyzed.
• Key outcomes included patient discharge rates via HIDAT, CT brain scans, and instances of clinically important traumatic brain injury or ED reattendance.

Main Results:

• Out of 1429 screened patients, 250 (18%) were discharged by nursing staff using the HIDAT tool.
• Only one CT scan was performed in the HIDAT-negative group, with normal findings.
• Four patients discharged via HIDAT reattended, experiencing minor issues like vomiting or scalp wound infections, with no imaging or admission required.

Conclusions:

• The HIDAT tool was successfully implemented into clinical practice for pediatric head injury management.
• The observed discharge rate of 18% was lower than anticipated, potentially influenced by multifactorial reasons including reduced ED attendances during the COVID-19 pandemic.
• The study suggests that while implementation was successful, the target population for HIDAT may not be currently utilizing emergency departments as frequently.