Di Fei, Gao Qi, Xiang Joe, Zhang Di, Shi Xiuquan, Yan Xueqiang, Zhu Huiping
Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
PLoS One. 2015 Nov 13;10(11):e0142983. doi: 10.1371/journal.pone.0142983. eCollection 2015.
Proper diagnosis and treatment of traumatic brain injury (TBI) in children is becoming an increasingly problematic issue in China. This study investigated Chinese clinicians to provide information about their knowledge and experiences in diagnosis and treatment of pediatric TBI. We conducted a questionnaire survey among clinicians in the emergency departments and neurosurgery departments at 9 major hospitals in China. The questionnaire included demographic information, and knowledge and experiences regarding the diagnosis and treatment of pediatric TBI. A total of 235 clinicians completed questionnaires. 43.8% of the surveyed clinicians reported children with only scalp hematoma without any other signs and symptoms of concussion as TBI cases. Most clinicians (85.1%) reported no existing uniform diagnostic criteria for children with TBI in China. The majority of clinicians (91.9%) reported that CT scans were performed in all patients with suspected head injury as a routine procedure in their hospitals. Only 20.9% of clinicians believed that radiation from CT scanning may increase cancer risk in children. About 33.6% of the clinicians reported that they ordered CT scans to investigate suspected head injury due to the poor doctor-patient relationship in China, and to protect themselves against any medical lawsuits in the future. About 80% of the clinicians reported that there are no existing pediatric TBI treatment guidelines in China. Instead a senior doctor's advice is the most reported guidelines regarding treating pediatric TBI (66.0%). All of the surveyed clinicians reported that the lack of diagnosis and/or treatment standard is the biggest problem in effectively diagnosing and treating pediatric TBI in China. Developing guidelines for the diagnosis and treatment of children with TBI is a high priority in China. The extremely high usage of CT for pediatric TBI in China suggests that it is important to establish evidence-based clinical decision rules to help Chinese clinicians make diagnostic and therapeutic decisions during their practice in order to identify children unlikely to have a clinically-important TBI who can be safely discharged without a CT scan.
儿童创伤性脑损伤（TBI）的正确诊断和治疗在中国正日益成为一个棘手的问题。本研究调查了中国临床医生，以了解他们在儿童TBI诊断和治疗方面的知识和经验。我们对中国9家大型医院急诊科和神经外科的临床医生进行了问卷调查。问卷包括人口统计学信息，以及关于儿童TBI诊断和治疗的知识与经验。共有235名临床医生完成了问卷。43.8%的受访临床医生将仅有头皮血肿而无任何其他脑震荡体征和症状的儿童报告为TBI病例。大多数临床医生（85.1%）报告称中国尚无统一的儿童TBI诊断标准。大多数临床医生（91.9%）报告说，在他们医院，对所有疑似头部受伤的患者进行CT扫描是常规程序。只有20.9%的临床医生认为CT扫描的辐射可能会增加儿童患癌症的风险。约33.6%的临床医生报告说，由于中国医患关系紧张，他们为调查疑似头部受伤情况而开具CT扫描，以便在未来保护自己免受任何医疗诉讼。约80%的临床医生报告说，中国尚无现有的儿童TBI治疗指南。相反，最常被报告的儿童TBI治疗指南是资深医生的建议（66.0%）。所有受访临床医生均报告称，缺乏诊断和/或治疗标准是中国有效诊断和治疗儿童TBI的最大问题。制定儿童TBI诊断和治疗指南在中国是当务之急。中国儿童TBI的CT使用率极高，这表明制定基于证据的临床决策规则很重要，以帮助中国临床医生在实践中做出诊断和治疗决策，从而识别出不太可能患有具有临床重要性的TBI且无需CT扫描即可安全出院的儿童。
