Clinical Practice Experiences in Diagnosis and Treatment of Traumatic Brain Injury in Children: A Survey among Clinicians at 9 Large Hospitals in China.
Clinical Practice Experiences in Diagnosis and Treatment of Traumatic Brain Injury in Children: A Survey among Clinicians at 9 Large Hospitals in China.
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儿童脑外伤诊治临床实践经验：国内9家大型医院临床医生调查。
DOI：
10.1371/journal.pone.0142983
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Zhu H
中科院分区：
文献类型：
--
作者：
Di F;Gao Q;Xiang J;Zhang D;Shi X;Yan X;Zhu H
在中国，儿童创伤性脑损伤（TBI）的正确诊断和治疗正成为一个日益严重的问题。本研究调查了中国临床医生，以提供有关他们在儿童 TBI 诊断和治疗方面的知识和经验的信息。我们对国内9家主要医院急诊科和神经外科的临床医生进行了问卷调查。调查问卷包括人口统计信息以及有关儿童 TBI 诊断和治疗的知识和经验。共有 235 名临床医生完成了问卷调查。 43.8%的受访临床医生将仅有头皮血肿而没有任何其他脑震荡体征和症状的儿童报告为TBI病例。大多数临床医生（85.1%）表示，中国目前尚无统一的儿童 TBI 诊断标准。大多数临床医生 (91.9%) 报告称，所有疑似头部受伤的患者都进行了 CT 扫描，作为医院的常规检查。只有 20.9% 的临床医生认为 CT 扫描的辐射可能会增加儿童患癌症的风险。约33.6%的临床医生表示，由于中国医患关系不佳，他们要求进行CT扫描来调查疑似头部受伤的情况，并保护自己免受未来任何医疗诉讼。约80%的临床医生表示，中国目前尚无儿童TBI治疗指南。相反，高级医生的建议是报道最多的有关治疗儿科 TBI 的指南 (66.0%)。所有接受调查的临床医生均表示，缺乏诊断和/或治疗标准是我国有效诊断和治疗儿童TBI的最大问题。制定儿童创伤性脑损伤的诊断和治疗指南是中国的当务之急。 CT 在中国儿童 TBI 中的使用率极高，这表明建立循证临床决策规则非常重要，以帮助中国临床医生在实践中做出诊断和治疗决策，从而识别出不太可能患有具有临床意义的 TBI 且无需 CT 扫描即可安全出院的儿童。
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.