Abstract

The purpose of the current study was to identify the variables associated with the risk of closed head injury (CHI) in children under age two with suspected minor head injuries based on age-appropriate, or near age-appropriate, mental status on exam, as defined by a Glascow Coma Score (GCS) of 15 or 14, respectively. The goal was to propose a set of variables that, when considered together, have a high degree of predictive accuracy in identifying CHI in this population. This set of variables could eventually be used to inform a clinical decision rule which may help triage nurses make acuity decisions in a more evidence-based manner. The study was guided by Donabedian's Structure, Process, Outcome model that allows for the assessment of the various factors that inform and influence the ED triage process. The current study was a secondary data analysis of the public-use dataset from the largest prospective, multi-center pediatric head injury study found in the current literature. As part of the secondary analysis, an existing clinical decision rule by Greenes and Schutzman (2001) (Greenes and Schutzman Risk Scoring System [the Scalp Score]), was examined using a sample of 3,329 children under age two to determine whether it, or the individual variables within it, could be utilized alone, or in conjunction with other variables to accurately predict the risk of underlying CHI in this population. In consideration of the factors related to best practice for clinical decision rule development, the optimal set of variables for a clinical decision rule to predict CHI in children under age two would include the following variables: age in months, a composite variable representing hematoma presence/size, and location; and severity of injury mechanism. An evidence-based, nurse-driven clinical decision rule designed as a risk scoring system could serve to improve the “structure” of ED triage. Such a resource could influence the “process” of the triage assessment and acuity assignation to be more accurate, ultimately also optimizing the primary “outcome” of triage accuracy for children under age two with CHIs. Such a tool could help overcome inconsistencies in triage acuity decisions due to variation in knowledge, thereby improving triage accuracy and consistency for children under age two who present for evaluation of suspected minor head injuries. The results of this study could also be used to inform more age-specific recommendations for children under age two in triage and educational resources and in national trauma criteria. The findings from this study add to the body of knowledge regarding what variables are, and are not, associated with CHI in children under age two with suspected minor head injuries. The key to an accurate triage assessment for children under age two with suspected minor head injuries includes familiarity with the main regions of the skull, being able to assess for the presence and size of any scalp hematoma and having access to accurate information regarding the child's age and the details of the injury mechanism.

Description

This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 10977906; ProQuest document ID: 2175723522. The author still retains copyright.

Author Details

Elizabeth L. Stone, PhD, MSN, CHSE, FAEN, Assistant Dean - UNC Chapel Hill

Sigma Membership

Non-member

Type

Dissertation

Format Type

Text-based Document

Study Design/Type

Other

Research Approach

Other

Keywords:

Head Injuries, Pediatrics, Triage

Advisors

Davis, Leslie||McCoy, Thomas||Travers, Debbie||Van Horn, Elizabeth

Degree

PhD

Degree Grantor

The University of North Carolina at Greensboro

Degree Year

2018

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2024-08-29

Full Text of Presentation

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