title: Clinical Practice Experiences in Diagnosis and Treatment of Traumatic Brain Injury in Children: A Survey among Clinicians at 9 Large Hospitals in China.
abstract: Proper diagnosis and treatment of traumatic brain injury (TBI) in children is becoming an increasingly problematic issue in China. This study investigated Chinese clinicians to provide information about their knowledge and experiences in diagnosis and treatment of pediatric TBI. We conducted a questionnaire survey among clinicians in the emergency departments and neurosurgery departments at 9 major hospitals in China. The questionnaire included demographic information, and knowledge and experiences regarding the diagnosis and treatment of pediatric TBI. A total of 235 clinicians completed questionnaires. 43.8% of the surveyed clinicians reported children with only scalp hematoma without any other signs and symptoms of concussion as TBI cases. Most clinicians (85.1%) reported no existing uniform diagnostic criteria for children with TBI in China. The majority of clinicians (91.9%) reported that CT scans were performed in all patients with suspected head injury as a routine procedure in their hospitals. Only 20.9% of clinicians believed that radiation from CT scanning may increase cancer risk in children. About 33.6% of the clinicians reported that they ordered CT scans to investigate suspected head injury due to the poor doctor-patient relationship in China, and to protect themselves against any medical lawsuits in the future. About 80% of the clinicians reported that there are no existing pediatric TBI treatment guidelines in China. Instead a senior doctor's advice is the most reported guidelines regarding treating pediatric TBI (66.0%). All of the surveyed clinicians reported that the lack of diagnosis and/or treatment standard is the biggest problem in effectively diagnosing and treating pediatric TBI in China. Developing guidelines for the diagnosis and treatment of children with TBI is a high priority in China. The extremely high usage of CT for pediatric TBI in China suggests that it is important to establish evidence-based clinical decision rules to help Chinese clinicians make diagnostic and therapeutic decisions during their practice in order to identify children unlikely to have a clinically-important TBI who can be safely discharged without a CT scan.
authors.affiliation: Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Di
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Gao
authors.affiliation: Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, Ohio, United States of America.
authors.forename: Joe
authors.initials: J
authors.lastname: Xiang
authors.affiliation: Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China.
authors.forename: Di
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China.
authors.forename: Xiuquan
authors.initials: X
authors.lastname: Shi
authors.affiliation: Department of Neurosurgery, Wuhan Children's Hospital, Wuhan, Hubei, China.
authors.forename: Xueqiang
authors.initials: X
authors.lastname: Yan
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
authors.forename: Huiping
authors.initials: H
authors.lastname: Zhu
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging; D001930:Brain Injuries / Q000175:diagnosis* / Q000628:therapy*; D002648:Child; D002681:China; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006406:Hematoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000379:methods; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D055815:Young Adult