PDF(Pubmed)
Abstract：
OBJECTIVE: Hospital-based clinical decision tools support clinician decision-making when a child presents to the emergency department with a head injury, particularly regarding CT scanning. However, there is no decision tool to support prehospital clinicians in deciding which head-injured children can safely remain at scene. This study aims to identify clinical decision tools, or constituent elements, which may be adapted for use in prehospital care.
METHODS: Systematic mapping review and narrative synthesis.
METHODS: Searches were conducted using MEDLINE, EMBASE, PsycINFO, CINAHL and AMED.
METHODS: Quantitative, qualitative, mixed-methods or systematic review research that included a clinical decision support tool for assessing and managing children with head injury.
METHODS: We systematically identified all in-hospital clinical decision support tools and extracted from these the clinical criteria used in decision-making. We complemented this with a narrative synthesis.
RESULTS: Following de-duplication, 887 articles were identified. After screening titles and abstracts, 710 articles were excluded, leaving 177 full-text articles. Of these, 95 were excluded, yielding 82 studies. A further 14 studies were identified in the literature after cross-checking, totalling 96 analysed studies. 25 relevant in-hospital clinical decision tools were identified, encompassing 67 different clinical criteria, which were grouped into 18 categories.
CONCLUSIONS: Factors that should be considered for use in a clinical decision tool designed to support paramedics in the assessment and management of children with head injury are: signs of skull fracture; a large, boggy or non-frontal scalp haematoma neurological deficit; Glasgow Coma Score less than 15; prolonged or worsening headache; prolonged loss of consciousness; post-traumatic seizure; amnesia in older children; non-accidental injury; drug or alcohol use; and less than 1 year old. Clinical criteria that require further investigation include mechanism of injury, clotting impairment/anticoagulation, vertigo, length of time of unconsciousness and number of vomits.
METHODS: Systematic mapping review and narrative synthesis.
METHODS: Searches were conducted using MEDLINE, EMBASE, PsycINFO, CINAHL and AMED.
METHODS: Quantitative, qualitative, mixed-methods or systematic review research that included a clinical decision support tool for assessing and managing children with head injury.
METHODS: We systematically identified all in-hospital clinical decision support tools and extracted from these the clinical criteria used in decision-making. We complemented this with a narrative synthesis.
RESULTS: Following de-duplication, 887 articles were identified. After screening titles and abstracts, 710 articles were excluded, leaving 177 full-text articles. Of these, 95 were excluded, yielding 82 studies. A further 14 studies were identified in the literature after cross-checking, totalling 96 analysed studies. 25 relevant in-hospital clinical decision tools were identified, encompassing 67 different clinical criteria, which were grouped into 18 categories.
CONCLUSIONS: Factors that should be considered for use in a clinical decision tool designed to support paramedics in the assessment and management of children with head injury are: signs of skull fracture; a large, boggy or non-frontal scalp haematoma neurological deficit; Glasgow Coma Score less than 15; prolonged or worsening headache; prolonged loss of consciousness; post-traumatic seizure; amnesia in older children; non-accidental injury; drug or alcohol use; and less than 1 year old. Clinical criteria that require further investigation include mechanism of injury, clotting impairment/anticoagulation, vertigo, length of time of unconsciousness and number of vomits.
摘要：
目的：以医院为基础的临床决策工具为临床医生的决策提供支持，特别是关于CT扫描。然而,没有决策工具来支持院前临床医生决定哪些头部受伤的儿童可以安全地留在现场。本研究旨在确定临床决策工具，或组成元素，可能适用于院前护理。
方法：系统映射回顾和叙事综合。
方法：使用MEDLINE进行搜索，EMBASE,PsycINFO,CINAHL和AMED。
方法：定量，定性，混合方法或系统综述研究，包括用于评估和管理颅脑损伤儿童的临床决策支持工具。
方法：我们系统地确定了所有院内临床决策支持工具，并从这些工具中提取了用于决策的临床标准。我们用叙事综合来补充这一点。
结果：重复数据消除后，共识别887篇文章。筛选标题和摘要后，710篇文章被排除在外，留下177篇文章全文。其中,95被排除在外，82项研究经过交叉核对，文献中还确定了另外14项研究，共96项分析研究。确定了25个相关的院内临床决策工具，涵盖67种不同的临床标准，分为18类。
结论：在设计用于支持护理人员评估和管理颅脑损伤儿童的临床决策工具中，应考虑的因素是：颅骨骨折的迹象；大，boggy或非额叶头皮血肿神经功能缺损;格拉斯哥昏迷评分低于15;长期或恶化的头痛;长时间的意识丧失;创伤后癫痫发作;年龄较大的儿童健忘症;非意外伤害;药物或酒精使用;和不到1岁。需要进一步研究的临床标准包括损伤机制，凝血障碍/抗凝，眩晕,昏迷时间的长短和呕吐的次数。
方法：系统映射回顾和叙事综合。
方法：使用MEDLINE进行搜索，EMBASE,PsycINFO,CINAHL和AMED。
方法：定量，定性，混合方法或系统综述研究，包括用于评估和管理颅脑损伤儿童的临床决策支持工具。
方法：我们系统地确定了所有院内临床决策支持工具，并从这些工具中提取了用于决策的临床标准。我们用叙事综合来补充这一点。
结果：重复数据消除后，共识别887篇文章。筛选标题和摘要后，710篇文章被排除在外，留下177篇文章全文。其中,95被排除在外，82项研究经过交叉核对，文献中还确定了另外14项研究，共96项分析研究。确定了25个相关的院内临床决策工具，涵盖67种不同的临床标准，分为18类。
结论：在设计用于支持护理人员评估和管理颅脑损伤儿童的临床决策工具中，应考虑的因素是：颅骨骨折的迹象；大，boggy或非额叶头皮血肿神经功能缺损;格拉斯哥昏迷评分低于15;长期或恶化的头痛;长时间的意识丧失;创伤后癫痫发作;年龄较大的儿童健忘症;非意外伤害;药物或酒精使用;和不到1岁。需要进一步研究的临床标准包括损伤机制，凝血障碍/抗凝，眩晕,昏迷时间的长短和呕吐的次数。
