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Head home: a prospective cohort study of a nurse-led paediatric head injury clinical decision tool at a district general hospital

Head home: a prospective cohort study of a nurse-led paediatric head injury clinical decision tool at a district general hospital
Head home: a prospective cohort study of a nurse-led paediatric head injury clinical decision tool at a district general hospital

Objectives: To assess if a nurse-led application of a paediatric head injury clinical decision tool would be safe compared with current practice. 

Methods: All paediatric (<17 years) patients with head injuries presenting to Frimley Park Emergency Department (ED), England from 1 May to 31 October 2018 were prospectively screened by a nurse using a mandated electronic 'Head Injury Discharge At Triage' questionnaire (HIDATq). We determined which patients underwent CT of brain and whether there was a clinically important intracranial injury or re-presentation to the ED. The negative predictive value of the screening tool was assessed. We determined what proportion of patients could have been sent home from triage using this tool. 


Results: Of the 1739 patients screened, 61 had CTs performed due to head injury (six abnormal) with a CT rate of 3.5% and 2% re-presentations. Of the entire cohort, 1052 screened negative. 1 CT occurred in this group showing no abnormalities. Of those screened negative, 349 (33%)/1052 had 'no other injuries' and 543 (52%)/1052 had 'abrasions or lacerations'. HIDATq's negative predictive value for CT was 99.9% (95% CI 99.4% to 99.9%) and 100% (95% CI 99.0% to 100%) for intracranial injury. The positive predictive value of the tool was low. Five patients screened negative and re-presented within 72 hours but did not require CT imaging. 


Conclusion: A negative HIDATq appears safe in our ED. Potentially 20% (349/1739) of all patients with head injuries presenting to our department could be discharged by nurses at triage with adequate safety netting advice. This increases to 50% (543/1739), if patients with lacerations or abrasions were given advice and discharged at triage. A large multicentre study is required to validate the tool.

head, paediatric emergency med, paediatrics, paediatric injury, trauma, head
1472-0205
680-685
Aldridge, Patrick
2869fb7c-3110-4fd9-96a3-595d2d6e74db
Castle, Heather
a87e0b43-5dc5-49d1-afd0-c8bff458898f
Phillips, Clare
46bf6f99-65d0-4f5b-80f9-42bdbad7cf65
Russell, Emma
eeb75b74-e3b9-4f03-9da3-a6f01a20c793
Guerrero-luduena, Richard
db129ad5-e7f4-427c-b834-34fd22d67537
Rout, Raj
ddff39c9-fb28-4a08-b249-114ed84e2d20
Aldridge, Patrick
2869fb7c-3110-4fd9-96a3-595d2d6e74db
Castle, Heather
a87e0b43-5dc5-49d1-afd0-c8bff458898f
Phillips, Clare
46bf6f99-65d0-4f5b-80f9-42bdbad7cf65
Russell, Emma
eeb75b74-e3b9-4f03-9da3-a6f01a20c793
Guerrero-luduena, Richard
db129ad5-e7f4-427c-b834-34fd22d67537
Rout, Raj
ddff39c9-fb28-4a08-b249-114ed84e2d20

Aldridge, Patrick, Castle, Heather, Phillips, Clare, Russell, Emma, Guerrero-luduena, Richard and Rout, Raj (2020) Head home: a prospective cohort study of a nurse-led paediatric head injury clinical decision tool at a district general hospital. Emergency Medicine Journal, 37 (11), 680-685. (doi:10.1136/emermed-2019-208892).

Record type: Article

Abstract

Objectives: To assess if a nurse-led application of a paediatric head injury clinical decision tool would be safe compared with current practice. 

Methods: All paediatric (<17 years) patients with head injuries presenting to Frimley Park Emergency Department (ED), England from 1 May to 31 October 2018 were prospectively screened by a nurse using a mandated electronic 'Head Injury Discharge At Triage' questionnaire (HIDATq). We determined which patients underwent CT of brain and whether there was a clinically important intracranial injury or re-presentation to the ED. The negative predictive value of the screening tool was assessed. We determined what proportion of patients could have been sent home from triage using this tool. 


Results: Of the 1739 patients screened, 61 had CTs performed due to head injury (six abnormal) with a CT rate of 3.5% and 2% re-presentations. Of the entire cohort, 1052 screened negative. 1 CT occurred in this group showing no abnormalities. Of those screened negative, 349 (33%)/1052 had 'no other injuries' and 543 (52%)/1052 had 'abrasions or lacerations'. HIDATq's negative predictive value for CT was 99.9% (95% CI 99.4% to 99.9%) and 100% (95% CI 99.0% to 100%) for intracranial injury. The positive predictive value of the tool was low. Five patients screened negative and re-presented within 72 hours but did not require CT imaging. 


Conclusion: A negative HIDATq appears safe in our ED. Potentially 20% (349/1739) of all patients with head injuries presenting to our department could be discharged by nurses at triage with adequate safety netting advice. This increases to 50% (543/1739), if patients with lacerations or abrasions were given advice and discharged at triage. A large multicentre study is required to validate the tool.

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More information

Accepted/In Press date: 20 June 2020
e-pub ahead of print date: 5 August 2020
Published date: November 2020
Keywords: head, paediatric emergency med, paediatrics, paediatric injury, trauma, head

Identifiers

Local EPrints ID: 449218
URI: http://eprints.soton.ac.uk/id/eprint/449218
ISSN: 1472-0205
PURE UUID: d5b3db18-2a25-4deb-82a7-1f22659963f9
ORCID for Richard Guerrero-luduena: ORCID iD orcid.org/0000-0002-1217-015X

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Date deposited: 19 May 2021 18:19
Last modified: 27 Apr 2022 02:01

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Contributors

Author: Patrick Aldridge
Author: Heather Castle
Author: Clare Phillips
Author: Emma Russell
Author: Raj Rout

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