Feasibility of Acute Concussion Management in the Emergency Department

描述(由申请人提供) 创伤性脑损伤在儿科人群中是一个重要的问题。90%的儿童创伤性脑损伤被送往急诊科，但只有8%的人住院。由于大多数患有轻度脑震荡的儿科患者因此被诊断为脑震荡而出院，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伤员安全康复至关重要。如果没有最先进的知识和临床工具，轻度脑外伤(MTBI)可能得不到诊断和治疗，使遭受mTBI的人出现功能问题的风险增加。血管紧张素转换酶和血管紧张素转换酶治疗计划是美国疾病控制与预防中心“抬头：实践中的脑损伤”工具包的一部分，供医生管理mTBI。采用急诊室的ACE和由急诊科医生系统地实施标准化的临床方案应通过确保准确的诊断、改善患者教育和遵守出院建议来改善管理。这项研究的目的是证明通过可行地应用以ACE和ACE护理计划的形式的系统程序来改善向急诊科(ED)呈现的mTBI的诊断和管理的能力。这项研究将由国家儿童医学中心和UPMC/匹兹堡儿童医院合作进行，具体目的是：(1)评估ACE和ACE关怀计划在急诊环境中标准化实施的可行性；(2)确定ACE和ACE-ED关怀计划是否可以由急诊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关怀计划是否会改善患者/家人的后续行为和患者的康复。我们设计这项研究分两个阶段进行：第一阶段建议就在急诊环境中使用ACE和ACE护理计划的重要性和可行性达成专家共识，包括了解当前脑震荡管理护理路径。第一阶段的成果将是以共识为基础对急症室的ACE和ACE关怀计划进行修改，称为ACE-ED和ACE-ED关怀计划。第二阶段通过一项试验性实施研究，将这些修订的工具应用于5-22岁表现为mTBI的患者。主要结果将是患者/家庭对初级保健/专科医生的后续行为。作为次要结果，我们将检查临床医生遵守ACE-ED和ACE-ED护理计划的使用情况，以及将其传播给初级保健提供者。将通过确定在ED环境中使用ACE-ED/关怀计划的实际促进条件和障碍条件，进一步评估实施的可行性。我们还将评估这一实施对患者康复的影响。研究完成后，将获得关键数据，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