Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, Surrey, UK.
Emerg Med J. 2021 Sep;38(9):692-693. doi: 10.1136/emermed-2020-211007. Epub 2021 Jul 21.
Recent research suggests that between 20% and 50% of paediatric head injuries attending our emergency department (ED) could be safely discharged soon after triage, without the need for medical review, using a 'Head Injury Discharge At Triage' tool (HIDAT). We sought to implement this into clinical practice.
Paediatric ED triage staff underwent competency-based assessments for HIDAT with all head injury presentations 1 May to 31 October 2020 included in analysis. We determined which patients were discharged using the tool, which underwent CT of the brain and whether there was a clinically important traumatic brain injury or representation to the ED.
Of the 1429 patients screened; 610 (43%) screened negative with 250 (18%) discharged by nursing staff. Of the entire cohort, 32 CTs were performed for head injury concerns (6 abnormal) with 1 CT performed in the HIDAT negative group (normal). Of those discharged using HIDAT, four reattended, two with vomiting (no imaging or admission) and two with minor scalp wound infections. Two patients who screened negative declined discharge under the policy with later medical discharge (no imaging or admission). Paediatric ED attendances were 29% lower than in 2018.
We have successfully implemented HIDAT into local clinical practice. The number discharged (18%) is lower than originally described; this is likely multifactorial. The relationship between COVID-19 and paediatric ED attendances is unclear but decreased attendances suggest those for whom the tool was originally designed are not attending ED and may be accessing other medical/non-medical resources.
最近的研究表明，在我们的急诊科（ED）就诊的儿童头部损伤中，有 20%到 50%可能通过使用“分诊时头部损伤出院”工具（HIDAT）在分诊后不久安全出院，无需医疗审查。我们试图将其应用于临床实践。
儿科 ED 分诊人员接受了 HIDAT 的基于能力的评估，包括 2020 年 5 月 1 日至 10 月 31 日期间所有头部损伤表现的患者。我们确定了使用该工具出院的患者、接受脑部 CT 检查的患者以及是否存在临床重要的创伤性脑损伤或到 ED 的就诊。
在筛选的 1429 名患者中；610 名（43%）筛查结果为阴性，其中 250 名（18%）由护理人员出院。在整个队列中，有 32 例头部损伤就诊行 CT 检查（6 例异常），其中 1 例 HIDAT 阴性组行 CT 检查（正常）。使用 HIDAT 出院的患者中有 4 例再次就诊，其中 2 例因呕吐（无影像学或入院），2 例因头皮小伤口感染。有 2 名筛查结果为阴性的患者根据政策拒绝出院，随后被医学出院（无影像学或入院）。儿科 ED 就诊人数比 2018 年下降了 29%。
我们已经成功地将 HIDAT 应用于当地的临床实践。出院人数（18%）低于最初描述的人数；这可能是多方面的。COVID-19 与儿科 ED 就诊人数的关系尚不清楚，但就诊人数减少表明，该工具最初设计的人群并未前往 ED，可能正在使用其他医疗/非医疗资源。
