Article Text

Download PDFPDF
Head home: a prospective cohort study of a nurse-led paediatric head injury clinical decision tool at a district general hospital
  1. Patrick Aldridge1,
  2. Heather Castle1,
  3. Clare Phillips1,
  4. Emma Russell1,
  5. Richard Guerrero-Luduena2,
  6. Raj Rout3
  1. 1Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
  2. 2School of Health Sciences, Centre for Implementation Science, University of Southampton, Southampton, Hampshire, UK
  3. 3Global Medical Affairs, Sanofi Genzyme, Guildford, UK
  1. Correspondence to Dr Patrick Aldridge, Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Camberley GU16 7UJ, UK; patrickjaldridge{at}hotmail.com

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.

  • trauma, head
  • paediatric emergency med
  • head
  • paediatrics, paediatric injury
View Full Text

Statistics from Altmetric.com

Footnotes

  • Handling editor Mary Dawood

  • Contributors PA is the overall guarantor who planned, conducted and reported the study. HC and RR planned and reported the study. ER and CP reported the study. RGL reported the study, including statistical analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Deidentified participant data available from main author, patrickjaldridge@hotmail.com. Data available for 2 years from publication. Reuse permitted in correspondence with main author. No additional information available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.