title: Effectiveness of the head CT choice decision aid in parents of children with minor head trauma: study protocol for a multicenter randomized trial.
abstract: BACKGROUND
  Blunt head trauma is a common cause of death and disability in children worldwide. Cranial computed tomography (CT), the reference standard for the diagnosis of traumatic brain injury (TBI), exposes children to ionizing radiation which has been linked to the development of brain tumors, leukemia, and other cancers. We describe the methods used to develop and test the effectiveness of a decision aid to facilitate shared decision-making with parents regarding whether to obtain a head CT scan or to further observe their child at home.
  
  
  METHODS
  This is a protocol for a multicenter clinician-level parallel randomized trial to compare an intervention group receiving a decision aid, 'Head CT Choice', to a control group receiving usual care. The trial will be conducted at five diverse emergency departments (EDs) in Minnesota and California. Clinicians will be randomized to decision aid or usual care. Parents visiting the ED with children who are less than 18-years-old, have experienced blunt head trauma within 24 hours, and have one or two risk factors for clinically-important TBI (ciTBI) from the Pediatric Emergency Care Applied Research Network head injury clinical prediction rules will be eligible for enrollment. We will measure the effect of Head CT Choice on: (1) parent knowledge regarding their child's risk of ciTBI, the available diagnostic options, and the risks of radiation exposure associated with a cranial CT scan (primary outcome); (2) parent engagement in the decision-making process; (3) the degree of conflict parents experience related to feeling uninformed; (4) patient and clinician satisfaction with the decision made; (5) the rate of ciTBI at seven days; (6) the proportion of patients in whom a cranial CT scan is obtained; and (7) seven-day healthcare utilization. To capture these outcomes, we will administer parent and clinician surveys immediately after each clinical encounter, obtain video recordings of parent-clinician discussions, administer parent healthcare utilization diaries, analyze hospital billing records, review the electronic medical record, and conduct telephone follow-up.
  
  
  CONCLUSIONS
  This multicenter trial will robustly assess the effectiveness of a decision aid on patient-centered outcomes, safety, and healthcare utilization in parents of children with minor head trauma in five diverse EDs.
  
  
  BACKGROUND
  ClinicalTrials.gov registration number: NCT02063087. Registration date February 13, 2014.
authors: Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, 55905 Rochester, MN, USA. hess.erik@mayo.edu.
authors: Erik P
authors: EP
authors: Hess
authors: Kirk D
authors: KD
authors: Wyatt
authors: Anupam B
authors: AB
authors: Kharbanda
authors: Jeffrey P
authors: JP
authors: Louie
authors: Peter S
authors: PS
authors: Dayan
authors: Leah
authors: L
authors: Tzimenatos
authors: Sandra L
authors: SL
authors: Wootton-Gorges
authors: James L
authors: JL
authors: Homme
authors: Laurie
authors: L
authors: Pencille R N
authors: Annie
authors: A
authors: LeBlanc
authors: Jessica J
authors: JJ
authors: Westphal
authors: Kathy
authors: K
authors: Shepel
authors: Nilay D
authors: ND
authors: Shah
authors: Megan
authors: M
authors: Branda
authors: Jeph
authors: J
authors: Herrin
authors: Victor M
authors: VM
authors: Montori
authors: Nathan
authors: N
authors: Kuppermann
mesh_terms: D002648:Child; D003220:Conflict, Psychological; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D003657:Decision Making; D003661:Decision Support Techniques; D006801:Humans; D010290:Parents; D012107:Research Design; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*; D015599:Trauma Severity Indices; D057832:Watchful Waiting / Q000379:methods*