J Korean Soc Emerg Med.  2016 Apr;27(2):189-198. 10.0000/jksem.2016.27.2.189.

Change in Guardians' Favor in Computed Tomography after Explained by Emergency Physicians in Pediatric Head Injury

Affiliations
  • 1Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju-si, Gyeongsangnam-do, Republic of Korea.
  • 2Department of Emergency Medicine, Seoul National University Hospital, Seoul College of Medicine, Seoul, Republic of Korea. gienee@snuh.org
  • 3Department of Emergency Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
  • 4Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
  • 5Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea.
  • 6Department of Emergency Medicine, Bohun Jungang Hospital, Seoul, Republic of Korea.

Abstract

PURPOSE
Head injury in children is a common problem presenting to emergency departments, and cranial computed tomography scan is the diagnostic standard for these patients. Several decision rules are used to determine whether computed tomography scans should be used; however, the use of computed tomography scans is often influenced by guardian favor toward the scans. The objective of this study was to identify changes in guardian favor for explanation of minor head injuries based on the institutional clinical practice guidelines.
METHODS
A survey was conducted between July 2010 and June 2012. Patients younger than 16 years with a Glasgow Coma Scale score of 15 after a head injury and guardians of these patients were included. Pre- and post-explanation questionnaires were administered to guardians to evaluate their favor for computed tomography scans and factors related to the degree of favor. Treating physicians explained the risks and benefits of cranial computed tomography scans using the institutional clinical practice guidelines. Guardian favor for a computed tomography (CT) scan was examined using a 100-mm visual analog scale.
RESULTS
A total of 208 patients and their guardians were included in this survey. Guardian favor for computed tomography scans was significantly reduced after explanation (46.7 vs. 17.4, p<0.01). Pre-explanation favor and the degree of physician recommending computed tomography were the most important factors affecting pre- and postexplanation changes in favor.
CONCLUSION
Explanation of the risks and benefits of cranial computed tomography scans using the institutional clinical practice guidelines may significantly reduce guardian favor for computed tomography scans.

Keyword

Head injury; Close; Pediatrics; Tomography; X-ray computed

MeSH Terms

Child
Craniocerebral Trauma*
Emergencies*
Emergency Service, Hospital
Glasgow Coma Scale
Head*
Humans
Pediatrics
Risk Assessment
Visual Analog Scale
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