Abstract：
BACKGROUND: Head injury is a common reason children present to EDs. Guideline development to improve care for paediatric head injuries should target the information needs of ED clinicians and factors influencing its uptake.
METHODS: We conducted semi-structured qualitative interviews (November 2017-November 2018) with a stratified purposive sample of ED clinicians from across Australia and New Zealand. We identified clinician information needs, used the Theoretical Domains Framework (TDF) to explore factors influencing the use of head CT and clinical decision rules/guidelines in CT decision-making, and explored ways to improve guideline uptake. Two researchers coded the interview transcripts using thematic content analysis.
RESULTS: A total of 43 clinicians (28 doctors, 15 nurses), from 19 hospitals (5 tertiary, 8 suburban, 6 regional/rural) were interviewed. Clinicians sought guidance for scenarios including ED management of infants, children with underlying medical issues, delayed or representations and potential non-accidental injuries. Improvements to the quality and content of discharge communication and parental discussion materials were suggested. Known risks of radiation from head CTs has led to a culture of observation over use of CT in Australasia (TDF domain: beliefs about consequences). Formal and informal policies have resulted in senior clinicians making most head CT decisions in children (TDF domain: behavioural regulation). Senior clinicians consider their gestalt to be more accurate and outperform existing guidance (TDF domain: beliefs about capabilities), although they perceive guidelines as useful for training and supporting junior staff. Summaries, flow charts, publication in ED-specific journals and scripted training materials were suggestions to improve uptake.
CONCLUSIONS: Information needs of ED clinicians, factors influencing use of head CT in children with head injuries and the role of guidelines were identified. These findings informed the scope and implementation strategies for an Australasian guideline for mild-to-moderate head injuries in children.
METHODS: We conducted semi-structured qualitative interviews (November 2017-November 2018) with a stratified purposive sample of ED clinicians from across Australia and New Zealand. We identified clinician information needs, used the Theoretical Domains Framework (TDF) to explore factors influencing the use of head CT and clinical decision rules/guidelines in CT decision-making, and explored ways to improve guideline uptake. Two researchers coded the interview transcripts using thematic content analysis.
RESULTS: A total of 43 clinicians (28 doctors, 15 nurses), from 19 hospitals (5 tertiary, 8 suburban, 6 regional/rural) were interviewed. Clinicians sought guidance for scenarios including ED management of infants, children with underlying medical issues, delayed or representations and potential non-accidental injuries. Improvements to the quality and content of discharge communication and parental discussion materials were suggested. Known risks of radiation from head CTs has led to a culture of observation over use of CT in Australasia (TDF domain: beliefs about consequences). Formal and informal policies have resulted in senior clinicians making most head CT decisions in children (TDF domain: behavioural regulation). Senior clinicians consider their gestalt to be more accurate and outperform existing guidance (TDF domain: beliefs about capabilities), although they perceive guidelines as useful for training and supporting junior staff. Summaries, flow charts, publication in ED-specific journals and scripted training materials were suggestions to improve uptake.
CONCLUSIONS: Information needs of ED clinicians, factors influencing use of head CT in children with head injuries and the role of guidelines were identified. These findings informed the scope and implementation strategies for an Australasian guideline for mild-to-moderate head injuries in children.
摘要：
背景：头部受伤是儿童出现ED的常见原因。改善小儿头部损伤护理的指南制定应针对ED临床医生的信息需求和影响其吸收的因素。
方法：我们对来自澳大利亚和新西兰的ED临床医生进行了半结构化定性访谈（2017年11月至2018年11月）。我们确定了临床医生的信息需求，使用理论域框架（TDF）来探索影响头部CT和临床决策规则/指南在CT决策中使用的因素，并探索了提高指南吸收的方法。两名研究人员使用主题内容分析对访谈记录进行编码。
结果：共有43名临床医生（28名医生，15名护士），来自19家医院(5家三级医院，8郊区，6个地区/农村)接受了采访。临床医生寻求有关情况的指导，包括婴儿的ED管理，有潜在医疗问题的孩子，延迟或陈述和潜在的非意外伤害。建议改善出院沟通和父母讨论材料的质量和内容。头部CT辐射的已知风险导致了在澳大利亚使用CT的观察文化（TDF领域：关于后果的信念）。正式和非正式的政策导致高级临床医生在儿童中做出大多数头部CT决定（TDF领域：行为调节）。高级临床医生认为他们的格式塔更准确，优于现有的指导（TDF领域：关于能力的信念），尽管他们认为指导方针对培训和支持初级员工很有用。摘要,流程图，在ED特定期刊上发表和脚本化培训材料是提高吸收的建议。
结论：ED临床医生的信息需求，确定了影响头部损伤儿童使用头部CT的因素以及指南的作用。这些发现为澳大利亚儿童轻度至中度头部受伤指南的范围和实施策略提供了依据。
方法：我们对来自澳大利亚和新西兰的ED临床医生进行了半结构化定性访谈（2017年11月至2018年11月）。
结果：共有43名临床医生（28名医生，
结论：ED临床医生的信息需求，
