Wiki Head CT Choice Study: Adaptation of US Two Decision Aids to a Québec Local Context

Launched by LAVAL UNIVERSITY · Oct 23, 2019

Keywords

ClinConnect Summary

Background: Mild traumatic brain injury (mTBI) is among the most common neurological conditions with an estimated annual incidence rate of 450 to 650/100,000 in Canada. Head computed tomography (CT) scans are used as the reference standard test to rule out life-threatening complications, such as intracranial hemorrhage, but present potential exposition risks for the patient. Despite the use of clinical decision rules (Canadian Head CT Rule; Pediatric Head Injury/Trauma Algorithm (PECARN)), head CTs remain overused. Two decision aids (pediatric and adult) developed in the United States (U.S....

Gender

ALL

Eligibility criteria

• Rapid-prototyping steps:
• Inclusion criteria:
• • For the pediatric decision aid: Parents seeking care for a child or an adolescent that are less than 18 years old. The child must have experienced blunt head trauma (above the eyebrows and not isolated to face or eyes).The child must have at least one of the PECARN risk factors for clinically important TBI (except for the two higher risk variables of altered mental status or signs of skull fracture).
• • For the adult decision aid: Adult participants that have had a diagnosis of mTBI before the interview or having a mTBI to be diagnosed by the physician at the moment and needs to make a decision about having a CTs.
• • Eligible clinicians will be attending physicians, fellows, and residents caring for children or adult with minor head trauma.
• Exclusion criteria:
• • For the pediatric decision aid: Suspected case of child abuse.
• • For the adult decision aid: No exclusion criteria.
• Retrospective analysis:
• Inclusion criteria:
• • Children that have experienced blunt head trauma (above the eyebrows and not isolated to face or eyes).
• • Children that have at least one of the PECARN risk factors for clinically important TBI (except for the two higher risk variables of altered mental status or signs of skull fracture).
• • Adults who have experienced blunt head trauma (above the eyebrows and not isolated to face or eyes) within 24 hours without any of the high risk or medium risk CCHR criteria that mandate performing a head CT.
• Exclusion criteria:
• • Children with signs of skull fracture, GCS \< 15 or other signs of altered mental status, brain tumour, penetrating head trauma, bleeding disorder or coagulopathy, ventricular shunt, preexisting neurological disease, syncope or seizure that preceded the head trauma, transferred to the ED with imaging already obtained, known pregnancy, suspected abuse, or \> 2 PECARN risk factors.
• • Adults that have a Glasgow coma scale less than 13, an obvious open skull fracture, take oral anticoagulants, or antiplatelet agents (excluding aspirin), or have a bleeding disorder, no causal factor of trauma (i.e. epilepsy, cardiac arrest), pregnancy, came back to emergency for the same head injury, no symptoms of head injury.