Feasibility of Acute Concussion Management in the Emergency Department

描述（申请人提供） 创伤性脑损伤（TBI）是儿科人群中的一个重要问题。90%的儿童TBI出现在急诊室，但只有8%住院。由于大多数患有轻度TBI的儿科患者因此被诊断为脑震荡而出院回家，因此准确评估脑震荡的严重程度以及随后的门诊管理和指导对于确保从损伤中安全恢复至关重要。如果没有最先进的知识和临床工具，轻度TBI（mTBI）可能无法诊断和治疗，使患有mTBI的人患功能问题的风险增加。ACE和ACE护理计划是作为CDC的“Heads Up：Brain Injury in Your Practice”工具包的一部分开发的，用于医生管理mTBI。通过调整艾德的ACE并由艾德医生系统地实施标准化的临床方案，可以通过确保准确诊断、改善患者教育和遵守出院建议来改善管理。本研究的目的是通过ACE和ACE护理计划形式的系统程序的可行应用，证明改善急诊科（艾德）mTBI诊断和管理的能力。本研究将由国家儿童医学中心和UPMC/匹兹堡儿童医院合作开展，具体目的是：（1）评估ACE和ACE护理计划在艾德环境中标准化实施的可行性（2）确定ACE和ACE-艾德护理计划是否可由艾德工作人员实施并传播给初级保健提供者，以及（3）确定常规使用ACE-ED和ACE-ED护理计划是否会改善患者/家属的随访行为和患者康复。我们将研究设计为分两个阶段进行：第1阶段建议就在艾德环境中使用ACE和ACE护理计划的重要性和可行性达成专家共识，包括了解当前的脑震荡管理护理途径。第1阶段的结果将是ACE和艾德ACE护理计划（称为ACE-艾德和ACE-艾德护理计划）基于共识的调整。第2阶段通过针对5-22岁mTBI患者的试点实施研究应用这些修订后的工具。主要结局将是患者/家庭对初级保健/专家的随访行为。作为次要结局，我们将检查临床医生对使用ACE-ED和ACE-ED护理计划的依从性，及其向初级保健提供者的传播。将通过确定在艾德环境中使用ACE-艾德/护理计划的实际促进和障碍条件，进一步评价实施的可行性。我们还将评估该实施对患者康复的影响。研究完成后，将提供关键数据，以支持

Description (Provided by Applicant) Traumatic brain injury (TBI) is a significant problem in the pediatric population. Ninety per cent of pediatric TBIs present to an emergency department, but only 8% are hospitalized. Since the majority of pediatric patients with mild TBI are therefore discharged home with the diagnosis of concussion, accurate assessment of the severity if concussion and consequent outpatient management and instructions are critical for ensuring safe recovery from injury. Without state-of-the-art knowledge and clinical tools, mild TBI (mTBI) may go undiagnosed and untreated, leaving individuals who have sustained a mTBI with an increased risk for functional problems. The ACE and ACE care plan were developed as part of the CDC's "Heads Up: Brain Injury in your Practice" toolkit for physicians to manage mTBI. Adapting the ACE for the ED and implementing a standardized clinical protocol by ED physicians systematically should improve management by ensuring accurate diagnosis and improving patient education and adherence with discharge recommendations. The goal of this research is to demonstrate the capacity to improve diagnosis and management of mTBI presenting to the Emergency Department (ED) by the feasible application of systematic procedures in the form of the ACE and the ACE Care Plan. This study will be conducted collaboratively by Children's National Medical Center and UPMC/ Children's Hospital of Pittsburgh with the specific aims to: (1) evaluate the feasibility of the ACE and ACE Care Plan for standardized implementation in the ED setting (2) determine if the ACE and ACE-ED Care Plan can be implemented by the ED staff and disseminated to the Primary Care Providers and (3) determine if routine use of the ACE-ED and ACE-ED Care Plan will improve patient/family follow-up behavior and patient recovery. We have designed the study to progress in two stages: Stage 1 proposes to develop expert consensus agreement regarding the importance and feasibility of using the ACE and ACE Care Plan in the ED setting, including an understanding of current concussion management care pathways. An outcome of Stage 1 will be the consensus-based adaptation of the ACE and ACE Care Plan for the ED, referred to as the ACE-ED and the ACE-ED Care Plan. Stage 2 applies these revised tools via a pilot implementation study for patients age 5-22 years old presenting with mTBI. The primary outcome will be patient/family follow-up behavior with the primary care/specialist. As secondary outcomes, we will examine clinician adherence to use of the ACE-ED and ACE-ED Care Plan, and its dissemination to primary care providers. Feasibility of implementation will be further evaluated by identifying the actual facilitative and barrier conditions to ACE-ED/ Care Plan use within the ED setting. We will also develop estimates of effect of this implementation on patient recovery. Upon study completion, key data will be available to support the development of