title: Change in guardians' preference for computed tomography after explanation by emergency physicians in pediatric head injury.
abstract: OBJECTIVE
  Head injury in children is a common problem presenting to emergency departments, and cranial computed tomography scanning 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 guardians' preference toward the scans. The objective of this study was to identify changes in guardian preference for minor head injuries after receiving an explanation based on the institutional clinical practice guideline.
  
  
  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 their guardians were included. Pre- and post-explanation questionnaires were given to guardians to assess their preference for computed tomography scans and factors related to the degree of preference. Treating physicians explained the risks and benefits of cranial computed tomography scanning using the institutional clinical practice guideline. Guardian preference for a computed tomography scan was examined using a 100-mm visual analog scale.
  
  
  RESULTS
  In total, 208 patients and their guardians were included in this survey. Guardian preference for computed tomography scans was significantly reduced after explanation (46.7 vs. 17.4, P<0.01). Pre-explanation preference and the strength of the physician recommendation to get a computed tomography were the most important factors affecting pre- and post-explanation changes in preferences.
  
  
  CONCLUSIONS
  Explanation of the risks and benefits of cranial computed tomography scans using the institutional clinical practice guideline may significantly reduce guardian preference for computed tomography scans.
authors.affiliation: Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Jeong
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea; Department of Emergency Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Kyuseok
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea.
authors.forename: Joong Eui
authors.initials: JE
authors.lastname: Rhee
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Tae Yun
authors.initials: TY
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: You Hwan
authors.initials: YH
authors.lastname: Jo
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Yu Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jae Hyuk
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea.
authors.forename: Changwoo
authors.initials: C
authors.lastname: Kang
authors.affiliation: Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea.
authors.forename: Soo Hoon
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Joonghee
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Veterans Health Service Medical Center, Seoul, Korea.
authors.forename: Chan Jong
authors.initials: CJ
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Hyuksool
authors.initials: H
authors.lastname: Kwon
keywords: Head injuries, closed; Pediatrics; Tomography, X-ray computed