Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, UK.
Emerg Med J. 2020 Nov;37(11):680-685. doi: 10.1136/emermed-2019-208892. Epub 2020 Aug 5.
To assess if a nurse-led application of a paediatric head injury clinical decision tool would be safe compared with current practice.
All paediatric (<17 years) patients with head injuries presenting to Frimley Park Emergency Department (ED), England from 1 May to 31 October 2018 were prospectively screened by a nurse using a mandated electronic 'Head Injury Discharge At Triage' questionnaire (HIDATq). We determined which patients underwent CT of brain and whether there was a clinically important intracranial injury or re-presentation to the ED. The negative predictive value of the screening tool was assessed. We determined what proportion of patients could have been sent home from triage using this tool.
Of the 1739 patients screened, 61 had CTs performed due to head injury (six abnormal) with a CT rate of 3.5% and 2% re-presentations. Of the entire cohort, 1052 screened negative. 1 CT occurred in this group showing no abnormalities. Of those screened negative, 349 (33%)/1052 had 'no other injuries' and 543 (52%)/1052 had 'abrasions or lacerations'. HIDATq's negative predictive value for CT was 99.9% (95% CI 99.4% to 99.9%) and 100% (95% CI 99.0% to 100%) for intracranial injury. The positive predictive value of the tool was low. Five patients screened negative and re-presented within 72 hours but did not require CT imaging.
A negative HIDATq appears safe in our ED. Potentially 20% (349/1739) of all patients with head injuries presenting to our department could be discharged by nurses at triage with adequate safety netting advice. This increases to 50% (543/1739), if patients with lacerations or abrasions were given advice and discharged at triage. A large multicentre study is required to validate the tool.
评估与现行做法相比，护士应用小儿头部损伤临床决策工具是否安全。
2018 年 5 月 1 日至 10 月 31 日期间，英国弗里姆利公园急诊部（ED）所有小儿（<17 岁）头部损伤患者均由护士使用强制性电子“分诊时头部损伤出院”问卷（HIDATq）进行前瞻性筛查。我们确定了哪些患者进行了脑部 CT 检查，以及是否存在临床重要的颅内损伤或再次到 ED 就诊。评估了筛查工具的阴性预测值。我们确定了使用该工具可以将多少患者从分诊处送回家。
在 1739 名接受筛查的患者中，有 61 名因头部损伤进行了 CT 检查（6 例异常），CT 率为 3.5%，2%再次出现。在整个队列中，有 1052 名患者筛查结果为阴性。这组中有 1 例 CT 检查结果正常。在筛查结果为阴性的患者中，有 349（33%）/1052 例“无其他损伤”，543（52%）/1052 例“擦伤或撕裂伤”。HIDATq 对 CT 的阴性预测值为 99.9%（95%CI 99.4%至 99.9%），对颅内损伤的阴性预测值为 100%（95%CI 99.0%至 100%）。该工具的阳性预测值较低。有 5 名筛查结果为阴性并在 72 小时内再次出现，但不需要 CT 成像。
在我们的 ED，阴性 HIDATq 似乎是安全的。如果在分诊时给予适当的安全网建议，我们部门就诊的所有头部损伤患者中有 20%（349/1739）可能由护士出院。如果给予擦伤或撕裂伤患者建议并在分诊处出院，则增加到 50%（543/1739）。需要一项大型多中心研究来验证该工具。
