Feasibility of Acute Concussion Management in the Emergency Department

急诊科急性脑震荡处理的可行性

• 批准号: 7571321
• 负责人: GERARD A. GIOIA
• 金额: $ 25万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7571321
• 关键词: Feasibility; Acute; Concussion; Management; Emergency

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

描述（由申请人提供） 创伤性脑损伤（TBI）是小儿人群中的一个重大问题。小儿TBI的90％出席了急诊室，但只有8％的住院治疗。因此，由于大多数轻度TBI的儿科患者在脑震荡诊断中被送入家乡，因此，如果脑震荡和随之而来的门诊管理和指示对于确保安全恢复受伤至关重要，则准确评估严重程度。如果没有最先进的知识和临床工具，轻度TBI（MTBI）可能未经诊断和未经治疗，这会使持有MTBI的个人患有功能问题的风险增加。 ACE和ACE护理计划是作为疾病预防控制中心（CDC）的“ Heads up：您的实践中的脑损伤”工具包制定的，供医生管理MTBI。将ACE适应ED并系统地实施ED医生的标准化临床方案，应通过确保准确的诊断并通过出院建议来改善患者的教育和依从性来改善管理。这项研究的目的是证明通过以ACE和ACE护理计划的形式可行地应用系统程序来改善MTBI向急诊科（ED）提出的诊断和管理能力。这项研究将由儿童国家医疗中心和匹兹堡的UPMC/儿童医院共同进行，其特定目的是：（1）评估ACE和ACE护理计划在ED环境中进行标准化实施的可行性（2）是否确定是否确定ED员工可以实施ACE和ACE-ED护理计划，并将其传播给初级保健提供者，（3）确定常规使用ACE-ED和ACE-ED护理计划是否会改善患者/家庭的随访行为和患者康复。我们已经设计了这项研究以在两个阶段进行进展：第1阶段提议建立有关在ED环境中使用ACE和ACE护理计划的重要性和可行性的专家共识协议，包括了解当前的脑震荡管理护理途径。第1阶段的结果将是对ED的ACE和ACE护理计划的共识改编，称为ACE-ED和ACE-ED护理计划。第2阶段通过针对5-22岁的MTBI的患者进行试点实施研究，应用了这些修订的工具。主要结果将是与初级保健/专家的患者/家庭随访行为。作为次要结果，我们将研究临床医生遵守使用ACE-ED和ACE-ED护理计划，并将其传播给初级保健提供者。通过确定ED环境中ACE-ED/护理计划的实际促进条件和障碍条件，将进一步评估实施的可行性。我们还将制定实施对患者康复的影响的估计。完成学习后，将可以使用关键数据来支持