Families’ perceptions of given information in relation to their child’s head injury

Service and support needs following pediatric brain injury: perspectives of children with mild traumatic brain injury and their parents

OBJECTIVE

To provide a qualitative examination of the service and support needs of children who have had a mild traumatic brain injury (mTBI), and their parents, in order to improve clinical services.

METHODS

Semi-structured interviews were conducted with 9 children (8-12 years; M = 10.6 years, SD = 0.8) and their parents (n = 9) 29-55 days (M = 34 days; SD = 9.3) after presenting to an Australian Paediatric Emergency Department (PED) for mTBI. Children's post-concussive symptoms (PCS) were additionally measured using the Post-Concussive Symptom Inventory (PCSI). Audio recordings were transcribed, and a thematic analysis was conducted.

RESULTS

Post-injury needs were reflected in four main themes: Communication; Family Burden; Continuity of Care; and Social and Community Support. These themes reflected children's and parents' needs for information, emotional/social/community support, and follow-up care. Both the children's and parents' needs, and the extent to which they were met, appeared to be related to the severity and duration of the child's PCS.

CONCLUSIONS

Dedicated pediatric mTBI follow-up services that build on family's resources and meet their individual needs for information, emotional support, and referral may assist in optimizing post-injury outcomes.

Italian guidelines on the assessment and management of pediatric head injury in the emergency department

OBJECTIVE

We aim to formulate evidence-based recommendations to assist physicians decision-making in the assessment and management of children younger than 16 years presenting to the emergency department (ED) following a blunt head trauma with no suspicion of non-accidental injury.

METHODS

These guidelines were commissioned by the Italian Society of Pediatric Emergency Medicine and include a systematic review and analysis of the literature published since 2005. Physicians with expertise and experience in the fields of pediatrics, pediatric emergency medicine, pediatric intensive care, neurosurgery and neuroradiology, as well as an experienced pediatric nurse and a parent representative were the components of the guidelines working group. Areas of direct interest included 1) initial assessment and stabilization in the ED, 2) diagnosis of clinically important traumatic brain injury in the ED, 3) management and disposition in the ED. The guidelines do not provide specific guidance on the identification and management of possible associated cervical spine injuries. Other exclusions are noted in the full text.

CONCLUSIONS

Recommendations to guide physicians practice when assessing children presenting to the ED following blunt head trauma are reported in both summary and extensive format in the guideline document.

Evaluation of Parent and Child Psychoeducation Resources for the Prevention of Paediatric Post-concussion Symptoms

Background: Persistent post-concussion symptoms (PCS) are associated with adverse psychosocial outcomes, including psychological distress and poorer health-related quality of life (HRQOL). Research has found that the occurrence of persistent PCS can be lowered via paper-based psychoeducation. Unfortunately, these resources have mostly been evaluated in adult populations. Studies in children have failed to address the role of parents in the development and maintenance of PCS, and unfortunately fail to reach a large proportion of the mild traumatic brain injury (mTBI) population who do not attend hospital. This study aimed to describe and evaluate a parent information booklet and child information website, for the prevention of paediatric PCS.

Methods: Children with uncomplicated mTBI were randomly assigned to either the Intervention (n = 29) or Usual Care condition (n = 20). Families completed pre-treatment, post-treatment (3 month) and follow-up (6 month) assessments of children's PCS, cognitive and psychosocial functioning, and parent's psychosocial functioning. Families also provided feedback on the psychoeducation resources.

Results: The Intervention programme, compared to Usual Care, was not associated with significant reductions in children's PCS or HRQOL, parent or child psychological distress, or parent or child knowledge of mTBI.

Conclusions: Psychoeducation resources do not appear to be superior to usual care in promotion of both child and parent psychosocial outcomes following mTBI.

Minor head injury in children: evaluating written discharge advice provided by Scottish emergency departments

OBJECTIVES

Emergency departments (EDs) routinely provide written information when a child with head injury (HI) is discharged home. This usually contains advice about recognizing signs of serious complications such as intracranial bleeding. This study evaluated the quality of discharge leaflets currently provided by Scottish emergency departments (EDs) by comparing them against written discharge advice recommended by the Scottish Intercollegiate Guideline Network (SIGN).

METHODS

All 35 EDs in Scotland which treat children were asked to send a copy of the advice leaflet provided when a child with HI is discharged. Leaflets were evaluated by awarding scores for the inclusion of specific aspects of health information as recommended by SIGN. The inclusion of serious warning symptoms (maximum 20 points) and other advice on observation and help-seeking (maximum 21 points) was assessed.

RESULTS

34 EDs provided leaflets. The median score for including serious warning symptoms was 10/20. The median score for including advice regarding observation and when to seek help was 6.5/21. Several leaflets contained unclear or contradictory advice.

CONCLUSION

Many leaflets did not include important information recommended by SIGN guidelines. There was considerable variation in the quality and clarity of written discharge advice provided. This may reduce the ability of parents to recognize rare but serious complications. It is recommended that a standardized HI information leaflet based on SIGN guidelines be used across all Scottish EDs.