Which management strategy do parents prefer for their head-injured child: immediate computed tomography scan or observation?

OBJECTIVE

The objectives of this study were to determine which method of head injury evaluation, immediate computed tomography (CT) or observation, parents would prefer for their child when given the opportunity to make an informed decision and to determine factors influencing preference.

METHODS

Parents of head-injured children 2 years or older who presented to a pediatric emergency department were eligible. After triage evaluation, and before physician assessment, research assistants presented educational materials regarding the method, risks, and benefits of both immediate CT and observation. Parents then completed a survey asking them their preference, reasons for preference, details of their child's injury, and demographic information.

RESULTS

One hundred thirty-four parents participated. After reviewing the educational materials, 53 (40%) preferred immediate CT; 77 (57%) preferred observation; 4 (3%) did not indicate a preference. Of those parents who preferred immediate CT, the leading reason given was, "I need to be 100% sure there is no bleeding in my child's brain." Of those parents who preferred observation, the 2 leading reasons given were, "I don't want my child to have a test unless he/she absolutely has to" and "I am concerned about the possibility of radiation causing a brain tumor." Injury mechanism, time between injury and presentation, time of day, child's age, worst symptom, previous CT, and demographic markers were not statistically associated with preference.

CONCLUSIONS

When given the opportunity to make an informed decision regarding the evaluation of their head-injured child, parents were divided as to their preference. A small majority preferred observation.