Intent of health care providers to adopt a clinical decision support tool in the management of minor pediatric head injuries

Abstract

Radiographic neuroimaging in minor pediatric head injuries contains risks of radiation-induced malignancy. The Pediatric Emergency Care Applied Research Network (PECARN) head injury protocol identifies head-injured children who are at very low risk of clinically important traumatic brain injuries and can safely not receive a head computed tomography (CT) scan. The identified urgent care facility had no facility-wide protocol to manage head injuries. The purpose of the evidence-based practice project was to educate health care providers on the risks of indiscriminate head CT prescription and the utility of the PECARN head injury protocol in the management of minor pediatric head injuries. A knowledge assessment was conducted using pre- and posttests and the likelihood to adopt the PECARN head injury protocol in clinical practice was evaluated using the Evidence-Based Practice Attitude Scale. Additionally, rates of head CT scans ordered that were inappropriate according to the PECARN head injury protocol were calculated postproject and compared with preproject rates. Data analysis was performed using descriptive statistics. Findings included increase in provider knowledge on the use of the PECARN head injury protocol and high likelihood of intent to adopt the PECARN head injury protocol in clinical practice. In addition, rates of head CT prescription postproject were lower than preproject rates, and 82.61% of CT scans ordered postproject were appropriate according to the PECARN head injury protocol. Using the PECARN head injury protocol was associated with consistency of care, reduced unnecessary health care resource utilization, and health care costs.