Clinical Practice Experiences in Diagnosis and Treatment of Traumatic Brain Injury in Children: A Survey among Clinicians at 9 Large Hospitals in China

Abstract

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.

Risk factors for positive brain CT scan in children with traumatic brain injury and GCS = 15

“…Unfortunately, in a survey among nine large hospitals in China, 80% of clinicians reported that there was no treatment guideline for pediatric TBI in China, 91.9% reported that CT scans were routinely performed in all suspected patients. [ 29 ] In regard to acute head CT use for conscious children, our finding might be helpful in clinical decision-making practices. CHALICE, PECARN, and CATCH are commonly used clinical decision rules, guiding CT use for children patients with mild TBI.…”

Development and Internal Validation of a Clinical Risk Score for Treating Children With Mild Head Trauma and Intracranial Injury

“…Children with mild TBI (mTBI)—those with Glasgow Coma Scale (GCS) scores of 13 to 15—comprise the most common TBI subgroup, constituting more than 90% of new pediatric TBI cases and approximately one-third of the 50 000 to 60 000 TBI hospitalizations each year . Despite the prevalence and potentially significant harms affecting children with mTBI, there is significant variability and often uncertainty in the treatment of these patients …”

“…5 Despite the prevalence and potentially significant harms affecting children with mTBI, there is significant variability and often uncertainty in the treatment of these patients. 6,7 In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) derived and validated clinical decision tools for identifying which children with minor head injuries are at risk for clinically important TBI. 8 While this study helped identify which children with minor head injuries should receive computed tomographic (CT) imaging, among those with intracranial injury (ICI) identified on CT, there is limited evidence guiding appropriate care pathways.…”

Clinico-radiologic Profile of Pediatric Traumatic Brain Injury in Western Rajasthan

“…There is, in general, nonavailability of on the spot resuscitation facility, poorly organized, equipped transport of patient and emergency services; lack of team approach the developing world like India. [ 4 ]…”