Evaluation of management and guideline adherence in children with mild traumatic brain injury

• Published in: Brain injury 2018-07, Vol.32 (8), p.1028-1039
• Main Authors: Broers, Merel C., Niermeijer, Jikke-Mien F., Kotsopoulos, Irene A.W., Lingsma, Hester F., Bruinenberg, Jos F.M., Catsman-Berrevoets, Coriene E.
• Format: Article
• Language: English
• Subjects: brain computed tomography; guideline compliance; hospital admission; Mild traumatic brain injury; minor head trauma
• ISSN: 0269-9052; 1362-301X
• DOI: 10.1080/02699052.2018.1469047

Aim: To evaluate the management and guideline adherence in children with mild traumatic brain injury (MTBI) in emergency departments (ED) in the Netherlands. Methods: A multicentre cohort study was conducted, including children younger than 18 years with MTBI who presented within 24 hours after trauma in the ED of hospitals in the southwest region of the Netherlands, in 2014. Primary outcome measures for management were percentages of performed computed tomography (CT) scans and hospital admissions. Guideline adherence was defined as percentages of correctly following the guideline. Secondary outcome measures were differences in management and guideline adherence between hospitals. Results: About 563 patients were analysed. Hospital admission was the most frequently performed management type (49.2% hospital admission vs. 30.9% CT). In only 49.7% of patients, the guideline was followed correctly. A substantial overuse of hospital admission (35%) and underuse of CT (40.1%) were found. Percentages of hospital admission and CT varied between 39.4-55.6% and 23.3-44.1%, respectively, across hospitals. Percentages of correctly following the guideline varied between 39.2-64.9% across hospitals. Conclusion: These findings suggest that physicians in the participating hospitals prefer hospital admission of children with MTBI instead of CT despite the current recommendations of the national MTBI guideline in the Netherlands.