Jeong Jin Hee, Lee Jin Hee, Kim Kyuseok, Rhee Joong Eui, Kim Tae Yun, Jo You Hwan, Kim Yu Jin, Lee Jae Hyuk, Kang Changwoo, Lee Soo Hoon, Kim Joonghee, Park Chan Jong, Kwon Hyuksool
Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea.
Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea; Department of Emergency Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
Clin Exp Emerg Med. 2015 Dec 28;2(4):226-235. doi: 10.15441/ceem.14.039. eCollection 2015 Dec.
Head injury in children is a common problem presenting to emergency departments, and cranial computed tomography scanning is the diagnostic standard for these patients. Several decision rules are used to determine whether computed tomography scans should be used; however, the use of computed tomography scans is often influenced by guardians' preference toward the scans. The objective of this study was to identify changes in guardian preference for minor head injuries after receiving an explanation based on the institutional clinical practice guideline.
A survey was conducted between July 2010 and June 2012. Patients younger than 16 years with a Glasgow Coma Scale score of 15 after a head injury and their guardians were included. Pre- and post-explanation questionnaires were given to guardians to assess their preference for computed tomography scans and factors related to the degree of preference. Treating physicians explained the risks and benefits of cranial computed tomography scanning using the institutional clinical practice guideline. Guardian preference for a computed tomography scan was examined using a 100-mm visual analog scale.
In total, 208 patients and their guardians were included in this survey. Guardian preference for computed tomography scans was significantly reduced after explanation (46.7 vs. 17.4, P<0.01). Pre-explanation preference and the strength of the physician recommendation to get a computed tomography were the most important factors affecting pre- and post-explanation changes in preferences.
Explanation of the risks and benefits of cranial computed tomography scans using the institutional clinical practice guideline may significantly reduce guardian preference for computed tomography scans.
儿童头部损伤是急诊科常见的问题，头颅计算机断层扫描是这些患者的诊断标准。有几种决策规则用于确定是否应进行计算机断层扫描；然而，计算机断层扫描的使用往往受到监护人对扫描的偏好影响。本研究的目的是确定在根据机构临床实践指南进行解释后，监护人对轻度头部损伤的偏好变化。
在2010年7月至2012年6月期间进行了一项调查。纳入头部受伤后格拉斯哥昏迷量表评分为15分的16岁以下患者及其监护人。在解释前后向监护人发放问卷，以评估他们对计算机断层扫描的偏好以及与偏好程度相关的因素。治疗医生使用机构临床实践指南解释头颅计算机断层扫描的风险和益处。使用100毫米视觉模拟量表检查监护人对计算机断层扫描的偏好。
本调查共纳入208例患者及其监护人。解释后监护人对计算机断层扫描的偏好显著降低（46.7对17.4，P<0.01）。解释前的偏好以及医生建议进行计算机断层扫描的力度是影响解释前后偏好变化的最重要因素。
使用机构临床实践指南解释头颅计算机断层扫描的风险和益处可能会显著降低监护人对计算机断层扫描的偏好。
