title: Mild traumatic brain injury in children: management practices in the acute care setting.
abstract: OBJECTIVE
  Accurate diagnosis, treatment and follow up of children suffering mild traumatic brain injury (MTBI) is important as post-concussive symptoms and long-term disability might occur. This research explored the decisions clinicians make in their assessment and management of children with MTBI in acute care settings, and identified barriers and enablers to the delivery of best-practice care.
  
  
  METHODS
  A purposeful sample of 29 clinicians employed in two metropolitan paediatric EDs and one Urgent Care clinic was surveyed using a vignette-based questionnaire that also included domains of guideline awareness, attitudes to MTBI care, use of clinical decision support systems, and knowledge and skills for practising evidence-based healthcare.
  
  
  RESULTS
  Overall, the evaluation and management of children presenting acutely with MTBI generally followed best-practice guidelines, particularly in relation to identifying intracranial injuries that might require surgical intervention, observation for potential deterioration, adequate pain management and the provision of written head injury advice on discharge. Larger variation emerged in regard to follow-up care and referral pathways. Potential barriers to best- practice were lack of guideline awareness, attitudes to MTBI, and lack of time or other priorities.
  
  
  CONCLUSIONS
  Opportunities exist to improve care for children who present in acute care settings following mild traumatic brain injury. These include having up-to-date guidelines that are consistent across acute care settings; providing clearer pathways for referral and follow up; targeting continuing medical education towards potential complications; and providing computerised decision support so that assessment and management are conducted systematically.
authors.affiliation: Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
authors.forename: Bridget
authors.initials: B
authors.lastname: Kool
authors.forename: Vivienne
authors.initials: V
authors.lastname: King
authors.forename: Carol
authors.initials: C
authors.lastname: Chelimo
authors.forename: Stuart
authors.initials: S
authors.lastname: Dalziel
authors.forename: Michael
authors.initials: M
authors.lastname: Shepherd
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Neutze
authors.forename: Nikki
authors.initials: N
authors.lastname: Chambers
authors.forename: Susan
authors.initials: S
authors.lastname: Wells
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001291:Attitude of Health Personnel; D001930:Brain Injuries / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D019468:Disease Management; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008297:Male; D009520:New Zealand; D059408:Pain Management / Q000592:standards; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: children; emergency department; evidence-based medicine; mild traumatic brain injury