Shared decision-making in children who have minor head injury

Erik P. Hess, M.D., leads this study to test the impact of a shared decision-making aid, the head CT choice. The goal is to determine if the head CT choice use improves parents' knowledge and engagement in decision-making and safely decreases health care utilization in children with minor head trauma who visit the emergency department.

Blunt head trauma is a common cause of death and disability in children worldwide. Children who require acute neurosurgical intervention should be identified rapidly, and a cranial computerized tomography (CT) scan is the reference standard test for the emergent diagnosis of traumatic brain injury (TBI) and is used to identify patients who require acute intervention. However, cranial CT for children with minor head trauma is greatly overutilized. Each year, more than 650,000 children visit U.S. emergency departments with apparently minor head trauma. Out of the children assessed annually, approximately 35 percent undergo head CT. Of these, fewer than 10 percent have evidence of TBI on CT and only 0.1 percent report an intracranial lesion requiring surgical intervention.

The decision aid increases parents' knowledge regarding head injury, engagement and satisfaction. Through this study, the rate of head CT might be decreased as well as a reduction in total health care utilization without significant increase in adverse events.