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Emergency Department Care of Young Children at Risk for Traumatic Brain Injury

What Are We Doing and Do Parents Understand?

Reilly, Caroline BS*; Zhang, Nanhua PhD; Babcock, Lynn MD, MS*; Wade, Shari L. PhD; Rhine, Tara MD, MS*

doi: 10.1097/PEC.0000000000001042
Original Articles

Objectives The aims of the study were to describe emergency department (ED) management of young children with head injury and to assess parental comfort level and perceptions of ED care.

Methods This was a prospective observational study of children younger than 5 years who presented to a pediatric ED after head injury. Children were eligible if clinical observation was an appropriate ED management option per the Pediatric Emergency Care Academic Research Network's neuroimaging clinical decision rule. Demographics, injury variables, and ED clinician surveys explaining the care provided were collected at time of study enrollment. Parents were subsequently contacted to assess understanding of ED management and comfort with care.

Results One hundred four children were enrolled with a mean (standard deviation) age of 1.19 (1.34) years. Thirty (29%) had emergent neuroimaging and 59 (57%) were placed into a period of observation per clinician report. A total of 37 children received a head computed tomography, of which 21 (57%) were normal. Eighty-four parents (81%) completed the phone follow-up. Of these children, there was a significant difference between whether parents and clinicians reported that the child had been clinically observed in the ED (P < 0.0001). Parents of children who did not receive a head CT were more likely to be uncomfortable with the decision to obtain neuroimaging compared with those who did receive a head CT (P = 0.003).

Conclusions Parents are not always comfortable with the medical care practices provided and are often unaware of clinical observation when it does occur. Better parent-clinician communication could improve parental understanding and reduce overall discomfort.

From the Divisions of *Emergency Medicine,

Biostatistics, and

Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Disclosure: The authors declare no conflict of interest.

Reprints: Tara Rhine, MD, MS, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 2008, Cincinnati, OH 45229 (e-mail:

This work was funded by Dr. Rhine's Emergency, Medical, Fire, & Transportation Research Grant from the Ohio Department of Public Safety.

An interim analysis of this article was presented as a poster presentation at the Pediatric Trauma Society's Annual Meeting in Scottsdale, AZ, November 6, 2015.

Online date: January 25, 2017

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