Erik P. Hess|James L. Homme|Anupam B. Kharbanda|Leah Tzimenatos|Jeffrey P. Louie|Daniel M. Cohen|Lise E. Nigrovic|Jessica J. Westphal|Nilay D. Shah|Jonathan Inselman|Michael Ferrara|Jeph Herrin|Víctor M. Montori|Nathan Kuppermann
Effect of the Head Computed Tomography Choice Decision Aid in Parents of Children With Minor Head Trauma
University of Alabama at Birmingham|Mayo Clinic|Mayo Clinic|Children's Minnesota|University of California, Davis|University of Minnesota|Nationwide Children's Hospital|Boston Children's Hospital|Mayo Clinic|Mayo Clinic in Arizona|Mayo Clinic in Arizona|Mayo Clinic|Yale University|Mayo Clinic|Children's Minnesota|University of California, Davis
pediatric emergency care applied research network prediction rules minor head trauma identify children low intermediate high risk clinically important traumatic brain injuries citbis recommend computed tomography ct low risk however prediction rules provide little guidance choice home observation ct children intermediate risk citbito compare decision aid usual care parents children intermediate risk citbithis cluster randomized trial conducted 7 geographically diverse us emergency departments eds april 1 2014 september 30 2016 eligible participants emergency clinicians children ages 2 18 years minor head trauma intermediate risk citbi parentsclinicians randomly assigned 11 ratio shared decisionmaking facilitated head ct choice decision aid usual carethe primary outcome selected parent stakeholders knowledge childs risk citbi available diagnostic options secondary outcomes included decisional conflict parental involvement decisionmaking ed ct rate 7day health care utilization missed citbia total 172 clinicians caring 971 children 493 decision aid 478 usual care minor head trauma intermediate risk citbi enrolled patient mean sd age 67 71 years 575 59 male 253 26 nonwhite race parents decision aid arm compared usual care arm greater knowledge mean sd questions correct 62 20 vs 53 20 mean difference 09 95 ci 0613 less decisional conflict mean sd decisional conflict score 148 155 vs 192 166 mean difference 44 95 ci 73 24 involved ct decisionmaking observing patient involvement option scores mean sd 250 85 vs 133 65 mean difference 117 95 ci 96139 although ed ct rate significantly differ decision aid 22 vs usual care 24 odds ratio 081 95 ci 051127 mean number imaging tests lower decision aid arm 7 days injury child missed citbiuse decision aid parents children intermediate risk citbi increased parent knowledge decreased decisional conflict increased involvement decisionmaking intervention significantly reduce ed ct rate safely decreased health care utilization 7 days injuryclinicaltrialsgov identifier nct02063087