Shared Decision Making in Parents of Children With Head Trauma: Head CT Choice
Head Injury
About this trial
This is an interventional health services research trial for Head Injury focused on measuring Head CT, Head Injury, Pediatric, Emergency Department, Decision Aids, Shared Decision Making
Eligibility Criteria
Inclusion Criteria:
Parents and their child, seeking care for a child who:
- Is < 18 years of age;
- Had blunt trauma above the eyebrows (not isolated to face or eyes);
- Is positive for at least 1 of the PECARN clinical prediction rule predictors described below:
PECARN Predictors for children < 2 years of age:
Severe mechanism (PECARN definition)* Loss of consciousness > 5 seconds Acting abnormally per parent Initial ED GCS < 15 by attending (or CT decision-maker) Other signs of altered mental status (PECARN definition) Presence of occipital, temporal or parietal scalp hematoma Palpable skull fracture or unclear if skull fracture
PECARN predictors for children 2-18 years of age:
Severe mechanism (PECARN definition)* Any loss of consciousness Any vomiting since the injury Severe headache in ED Initial ED GCS < 15 by attending (or CT decision-maker) Other signs of altered mental status (PECARN definition)** Any sign of basilar skull fracture Clinicians include attending physicians and fellows or midlevel providers caring for children with head trauma
Exclusion Criteria:
Parents of children with:
- GCS scores < 15
- Evidence of penetrating trauma, signs of basilar skull fracture, or depressed skull fracture on physical examination
- Brain tumors
- Ventricular shunts
- Bleeding disorder
- Pre-existing neurological disorders complicating assessment
- Neuroimaging at an outside hospital before transfer
- Signs of altered mental status (agitation, somnolence, repetitive questioning, or slow response to verbal communication)
- Syncope or seizure disorder preceded (led to) head trauma or seizure post head trauma
- Known to be pregnant
- Communication barriers such as visual or hearing impairment that may preclude use of the decision aid.
- Strong suspicion of abuse for this head injury
Sites / Locations
- University of California, Davis Medical Center
- Boston Children's Hospital
- Children's Hospitals and Clinics of MN, Minneapolis
- University of Minnesota Masonic Children's Hospital
- Mayo Clinic
- Children's Hospitals and Clincis of MN, St Paul ED
- Nationwide Children's Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
No Intervention
Decision Aid
Usual Care
Head CT Decision Aid
Clinicians and patients do not have access to the Head CT Decision Aid