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Abstract：
OBJECTIVEThere remains uncertainty regarding the appropriate level of care and need for repeating neuroimaging among children with mild traumatic brain injury (mTBI) complicated by intracranial injury (ICI). This study\'s objective was to investigate physician practice patterns and decision-making processes for these patients in order to identify knowledge gaps and highlight avenues for future investigation.METHODSThe authors surveyed residents, fellows, and attending physicians from the following pediatric specialties: emergency medicine; general surgery; neurosurgery; and critical care. Participants came from 10 institutions in the United States and an email list maintained by the Canadian Neurosurgical Society. The survey asked respondents to indicate management preferences for and experiences with children with mTBI complicated by ICI, focusing on an exemplar clinical vignette of a 7-year-old girl with a Glasgow Coma Scale score of 15 and a 5-mm subdural hematoma without midline shift after a fall down stairs.RESULTSThe response rate was 52% (n = 536). Overall, 326 (61%) respondents indicated they would recommend ICU admission for the child in the vignette. However, only 62 (12%) agreed/strongly agreed that this child was at high risk of neurological decline. Half of respondents (45%; n = 243) indicated they would order a planned follow-up CT (29%; n = 155) or MRI scan (19%; n = 102), though only 64 (12%) agreed/strongly agreed that repeat neuroimaging would influence their management. Common factors that increased the likelihood of ICU admission included presence of a focal neurological deficit (95%; n = 508 endorsed), midline shift (90%; n = 480) or an epidural hematoma (88%; n = 471). However, 42% (n = 225) indicated they would admit all children with mTBI and ICI to the ICU. Notably, 27% (n = 143) of respondents indicated they had seen one or more children with mTBI and intracranial hemorrhage demonstrate a rapid neurological decline when admitted to a general ward in the last year, and 13% (n = 71) had witnessed this outcome at least twice in the past year.CONCLUSIONSMany physicians endorse ICU admission and repeat neuroimaging for pediatric mTBI with ICI, despite uncertainty regarding the clinical utility of those decisions. These results, combined with evidence that existing practice may provide insufficient monitoring to some high-risk children, emphasize the need for validated decision tools to aid the management of these patients.
摘要：
目的：在轻度创伤性脑损伤（mTBI）并发颅内损伤（ICI）的儿童中，对于适当的护理水平和重复神经影像学检查的需求仍然不确定。本研究的目的是调查这些患者的医生实践模式和决策过程，以确定知识差距并为未来的调查指明途径。方法作者调查了居民，研究员，以及以下儿科专业的主治医师：急诊医学；普外科；神经外科和重症监护。参与者来自美国的10个机构和加拿大神经外科学会维护的电子邮件列表。调查要求受访者指出对ICI并发mTBI儿童的管理偏好和经验，重点是一名7岁女孩的示例性临床小插曲，格拉斯哥昏迷评分为15分，硬膜下血肿为5毫米，下楼梯后无中线移位。结果有效率为52%(n=536)。总的来说,326名（61％）的受访者表示，他们会建议在小插图中为儿童入住ICU。然而,只有62例(12%)同意/强烈同意该儿童存在神经系统衰退的高风险.一半的受访者（45％；n=243）表示他们将订购计划的随访CT（29％；n=155）或MRI扫描（19％；n=102），尽管只有64人(12%)同意/强烈同意重复神经成像会影响他们的管理。增加ICU入院可能性的常见因素包括存在局灶性神经功能缺损（95％；n=508认可），中线移位（90％；n=480）或硬膜外血肿（88％；n=471）。然而,42％（n=225）表示他们会将所有患有mTBI和ICI的儿童送入ICU。值得注意的是,27％（n=143）的受访者表示，他们曾看到一个或多个患有mTBI和颅内出血的儿童在去年进入普通病房时表现出神经系统迅速下降。13％（n=71）在过去一年中至少两次目睹了这一结果。结论许多医生支持ICU入住并对患有ICI的儿童mTBI进行重复神经影像学检查，尽管这些决定的临床效用不确定。这些结果,结合现有做法可能对一些高危儿童提供的监测不足的证据，强调需要经过验证的决策工具来帮助这些患者的管理。
