Broers Merel C, Niermeijer Jikke-Mien F, Kotsopoulos Irene A W, Lingsma Hester F, Bruinenberg Jos F M, Catsman-Berrevoets Coriene E
a Department of Paediatric Neurology , Erasmus University Hospital - Sophia Children's Hospital , Rotterdam , The Netherlands.
b Department of Neurology , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands.
Brain Inj. 2018;32(8):1028-1039. doi: 10.1080/02699052.2018.1469047. Epub 2018 May 18.
To evaluate the management and guideline adherence in children with mild traumatic brain injury (MTBI) in emergency departments (ED) in the Netherlands.
A multicentre cohort study was conducted, including children younger than 18 years with MTBI who presented within 24 hours after trauma in the ED of hospitals in the southwest region of the Netherlands, in 2014. Primary outcome measures for management were percentages of performed computed tomography (CT) scans and hospital admissions. Guideline adherence was defined as percentages of correctly following the guideline. Secondary outcome measures were differences in management and guideline adherence between hospitals.
About 563 patients were analysed. Hospital admission was the most frequently performed management type (49.2% hospital admission vs. 30.9% CT). In only 49.7% of patients, the guideline was followed correctly. A substantial overuse of hospital admission (35%) and underuse of CT (40.1%) were found. Percentages of hospital admission and CT varied between 39.4-55.6% and 23.3-44.1%, respectively, across hospitals. Percentages of correctly following the guideline varied between 39.2-64.9% across hospitals.
These findings suggest that physicians in the participating hospitals prefer hospital admission of children with MTBI instead of CT despite the current recommendations of the national MTBI guideline in the Netherlands.
评估荷兰急诊科中轻度创伤性脑损伤（MTBI）患儿的管理情况及对指南的遵循情况。
开展了一项多中心队列研究，纳入2014年在荷兰西南部地区医院急诊科创伤后24小时内就诊的18岁以下MTBI患儿。管理的主要结局指标为计算机断层扫描（CT）检查的执行率和住院率。指南遵循情况定义为正确遵循指南的比例。次要结局指标为各医院在管理和指南遵循方面的差异。
共分析了约563例患者。住院是最常采用的管理方式（49.2%住院 vs. 30.9% CT检查）。仅49.7%的患者正确遵循了指南。发现存在大量过度住院（35%）和CT检查使用不足（40.1%）的情况。各医院的住院率和CT检查率分别在39.4 - 55.6%和23.3 - 44.1%之间。各医院正确遵循指南的比例在39.2 - 64.9%之间。
这些研究结果表明，尽管荷兰国家MTBI指南有当前建议，但参与研究的医院医生更倾向于让MTBI患儿住院而非进行CT检查。
