title: Pediatric Traumatic Brain Injury: Families and Healthcare Team Interaction Trajectories During Acute Hospitalization.
abstract: OBJECTIVE
  To identify common or unique family-healthcare team interactions during acute hospitalization for pediatric patients with a traumatic brain injury (TBI) using a life course trajectory (LCT) theoretical approach.
  
  
  METHODS
  A 3-year prospective observational study of 35 children, ages 5 days to 15 years who were admitted to an urban Level-1 trauma hospital for a TBI. We defined brain injury severity using the admission Glasgow Coma Scale score (mild 13-15, moderate 9-12, and severe 3-8). Using a life course trajectory theoretical approach, we extracted from the patient's electronic health record the first eight-days of hospitalization and plotted the number and type of daily family-healthcare team interactions to visualize patterns or phases.
  
  
  RESULTS
  A general trajectory for each severity group was determined. When individually compared, family trajectories were similar based on injury severity. Visual interpretations of family-healthcare interactions based on the brain injury severity yielded three phases. The interactions phases included: (1) information seeking, (2) watchful waiting and (3) decision making.
  
  
  CONCLUSIONS
  Using a LCT approach, phases identified based on injury severity and family interactions support the need for proper timing of tailored communication and support. The findings also support the development of future best care practices that facilitate family's needs, decrease caregiver burden to improve functional outcomes.
authors.affiliation: Duke University School of Nursing, Durham, NC, USA; Duke University School of Medicine, Department of Pediatrics, Durham, NC, USA; Duke Institute for Brain Sciences, Durham, NC, USA. Electronic address: karin.reuter-rice@duke.edu.
authors.forename: Karin
authors.initials: K
authors.lastname: Reuter-Rice
authors.affiliation: Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Karoline
authors.initials: K
authors.lastname: Doser
authors.affiliation: Duke University Health Systems, Durham, NC, USA.
authors.forename: Julia K
authors.initials: JK
authors.lastname: Eads
authors.affiliation: Duke University School of Nursing, Durham, NC, USA.
authors.forename: Suzanna
authors.initials: S
authors.lastname: Berndt
mesh_terms: D000046:Academic Medical Centers; D000208:Acute Disease; D000293:Adolescent; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D000066491:Clinical Decision-Making / Q000379:methods; D005260:Female; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D057226:Information Seeking Behavior; D033183:Interdisciplinary Communication; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D011368:Professional-Family Relations; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014505:Urban Population; D057832:Watchful Waiting / Q000379:methods
keywords: Brain injury severity; Children; Family-healthcare team interactions; Head injury; Life course trajectory; Outcomes