- Blunt head trauma is the leading cause of trauma-related death and disability in children worldwide. Every year in the United States, more than 450,000 children present to the emergency department (ED) for evaluation of a head injury. With the increased availability and speed of contemporary computed tomography (CT) imaging, clinicians obtain cranial CT imaging in 37% to 50% of children with minor head trauma in the U.S. Fewer than 10% of these CT scans, however, show evidence of traumatic brain injury (TBI) and only 0.2% require neurosurgical intervention.
- In order to avoid unnecessary CT imaging and limit ionizing radiation exposure, the Pediatric Emergency Care Applied Research Network (PECARN) developed two clinical prediction rules to help identify patients at risk for clinically important traumatic brain injury (ciTBI) – one for children younger than 2 years old and one for children 2-18 years old.
- We developed decision aids (DA’s) to facilitate shared decision making between providers and care givers with regards to imaging pediatric patients not determined to be at very low risk for ciTBI based on the PECARN Rules. Head CT Choice DA’s were studied against usual care in a multicenter randomized trial and were found to improve caregiver knowledge and engagement in decision making as well as decrease 7 day healthcare utilization rates without missing important injuries.
Tools:
Risk Matrix:
After using the risk matrix to determine the patient’s calculated risk of ciTBI based on one or two intermediate risk factors, select the corresponding Head CT Choice SDM tool from the list below.
The SDM tool can be printed out or displayed on a screen to facilitate discussion and shared decision making with the care provider.
SDM Tools
Ped Head CT DA 1-100 Ped Head CT DA 1-1000
Ped Head CT DA 2-100 Ped Head CT DA 2-1000
Ped Head CT DA 3-100 Ped Head CT DA 3-1000
Ped Head CT DA 4-100
Ped Head CT DA 5-100
SDM tools in practice:
- Video demonstration of how to use the decision aid
DISCLAIMER: No SDM tool replaces the conversation patients should have with their clinicians to make important, clinical decisions. Use of these SDM tools carries no liability to its developers or to the Mayo Clinic Foundation for Education and Research.
Feedback
If you download our SDM tools, we would love to hear from you! Please send us a note at kerunit@mayo.edu to let us know who you are, why you are interested in the SDM tool(s), and how you plan to use them. Remember to check back to this page periodically to make sure you are using the most up-to-date version(s).