Abstract
Proper diagnosis and treatment of traumatic brain injury (TBI) in children is becoming an increasingly problematic issue in China. This study investigated Chinese clinicians to provide information about their knowledge and experiences in diagnosis and treatment of pediatric TBI. We conducted a questionnaire survey among clinicians in the emergency departments and neurosurgery departments at 9 major hospitals in China. The questionnaire included demographic information, and knowledge and experiences regarding the diagnosis and treatment of pediatric TBI. A total of 235 clinicians completed questionnaires. 43.8% of the surveyed clinicians reported children with only scalp hematoma without any other signs and symptoms of concussion as TBI cases. Most clinicians (85.1%) reported no existing uniform diagnostic criteria for children with TBI in China. The majority of clinicians (91.9%) reported that CT scans were performed in all patients with suspected head injury as a routine procedure in their hospitals. Only 20.9% of clinicians believed that radiation from CT scanning may increase cancer risk in children. About 33.6% of the clinicians reported that they ordered CT scans to investigate suspected head injury due to the poor doctor-patient relationship in China, and to protect themselves against any medical lawsuits in the future. About 80% of the clinicians reported that there are no existing pediatric TBI treatment guidelines in China. Instead a senior doctor’s advice is the most reported guidelines regarding treating pediatric TBI (66.0%). All of the surveyed clinicians reported that the lack of diagnosis and/or treatment standard is the biggest problem in effectively diagnosing and treating pediatric TBI in China. Developing guidelines for the diagnosis and treatment of children with TBI is a high priority in China. The extremely high usage of CT for pediatric TBI in China suggests that it is important to establish evidence-based clinical decision rules to help Chinese clinicians make diagnostic and therapeutic decisions during their practice in order to identify children unlikely to have a clinically-important TBI who can be safely discharged without a CT scan.
Highlights
Traumatic brain injury (TBI) is the leading cause of death and disability in children around the world, and accounts for approximately half of all trauma deaths [1]
Among those clinical decision rules (CDRs), the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK [16], the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada [15], and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the U.S have been identified as being of high quality and accuracy [13,23,25]
Results of our study showed that 43.8% of the surveyed clinicians reported children with only scalp hematoma as TBI cases, and 20.9% of the clinicians reported they do not know how to diagnose pediatric TBI correctly
Summary
Traumatic brain injury (TBI) is the leading cause of death and disability in children around the world, and accounts for approximately half of all trauma deaths [1]. In order to optimize the balance between identifying clinically important TBI (requiring intervention such as intubation, neurosurgery and hospital admission) and minimizing the cancer risk associated with cranial CT, several evidence-based clinical decision rules (CDRs) for pediatric HI have been developed to help clinicians identify children with mild TBI who can be observed without CT in developed countries [9,13,14,15,16,21,23,24,25] Among those CDRs, the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK [16], the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada [15], and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the U.S have been identified as being of high quality and accuracy [13,23,25]. Since children with HI are often first seen and treated by emergency physicians, in this study we conducted a survey among clinicians at EDs and neurosurgery departments (NDs) in order to gain an understanding of clinician’s knowledge and experiences in diagnosing and treating pediatric TBI, and whether there are clinical guidelines or CDRs that guide their clinical practices
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
