title: Mild traumatic brain injury: improving quality of care in the paediatric emergency department setting.
abstract: OBJECTIVE
  Traumatic brain injury (TBI) in childhood can impose a significant threat to life and longer-term disability. This study investigated the extent to which the documentation of key indicators of healthcare quality in the emergency department (ED) setting was consistent with clinical guidelines for the management of children with mild TBI (MTBI).
  
  
  METHODS
  The clinical records of a random sample of 60 children (stratified by ethnicity and age group), who were seen and discharged from a large metropolitan paediatric hospital ED following a head injury, were systematically reviewed to examine the processes of care and follow-up.
  
  
  RESULTS
  Based on the documentation in clinical records, processes designed to identify and manage potentially life-threatening acute complications (e.g. computed tomography scanning to identify intracranial haemorrhage) were consistent with best practice standards. However gaps existed between current and best practice for some aspects of care that could minimise risks of longer-term disability from MTBI. For example, relevant clinical criteria were well documented, but this information did not appear to be applied systematically to identify and to follow up children with definite or possible MTBI.
  
  
  CONCLUSIONS
  The apparent absence of a systematic approach to the diagnosis and follow-up of MTBI in children presenting to ED suggests a missed opportunity to minimise the risk of disability following these injuries. Greater attention to an integrated care pathway that improves the identification, documentation, and follow-up of children with MTBI presenting to ED is required.
authors.affiliation: Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sharpe
authors.forename: Bridget
authors.initials: B
authors.lastname: Kool
authors.forename: Michael
authors.initials: M
authors.lastname: Shepherd
authors.forename: Stuart
authors.initials: S
authors.lastname: Dalziel
authors.forename: Shanthi
authors.initials: S
authors.lastname: Ameratunga
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D016489:Head Injuries, Closed / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies