What You See is Not (Necessarily) What You Get: A Retrospective Chart Review of Pediatric Head Injuries

2.50
Hdl Handle:
http://hdl.handle.net/10755/198356
Title:
What You See is Not (Necessarily) What You Get: A Retrospective Chart Review of Pediatric Head Injuries
Abstract:
[ENA Annual Conference 2011 - Research Presentation]What You See is Not (Necessarily) What You Get: A Retrospective Chart Review of Pediatric Head Injuries

Purpose: The triage nurse is the first stop for most ED patients. It is the burden of the ED triage nurse to identify those children who may be at risk for a head injury which could require medical or neurosurgical intervention. The assessment of pediatric head injuries is especially challenging, even for the experienced triage nurse, because “signs and symptoms of head injuries in children to not correlate well with the risk of intracranial injuries.” At present, no nursing triage tool specific to pediatric head injuries exists. The purpose of this study was to identify the subjective and objective clinical findings which are highly associated with serious head injury in children aged newborn through seventeen.

Design: A staff nurse in a children’s emergency department (CED) conducted a retrospective chart review of 100 CED patients aged newborn to 17 from 2005 - 2009 with a final diagnosis of skull fracture and/or intracranial hemorrhage. Specific focus was given to the data received (by patient assessment and parent report) at triage.

Setting: The CED is part of a teaching, urban, level one trauma center in a capital city of the southern United States that sees appx 42,000 patients per year.

Participants/Subjects: IRB expedited approval was received for this study. The inclusion criteria for the retrospective chart review was all CED patients who were seen between 6/24/2005 – 12/31/2009 and who had a final diagnosis of skull fracture and/or intracranial hemorrhage (by radiographic study). Exclusion criteria included patients brought in as Trauma Ones, as well as patients with pre-existing conditions which increased their chance of sustaining a serious head injury.

Methods: Non-identifying information for each enrolled patient was recorded on a data collection form. Information included but was not limited to: age, mechanism of injury, location of injury, signs and symptoms present at triage, radiographic study findings, and final patient disposition. Results were combined and analyzed in order to identify commonalities that could be reported.

Results/Outcomes: The temporal-parietal region was the most frequent site of serious head injury, with a 60% (N=60) rate of injury. Several mechanisms of injury were more likely to result in a serious head injury, including falls out of shopping carts and infants who were dropped or fell. 44% (N=44) of the serious head injuries were in children under 2 years of age. Only 15% (N=15) of the children with serious head injuries had a positive LOC reported following their injury. Most alarming was that 32% (N=32) of children with a serious head injury showed no symptoms at all other than a hematoma.

Implications: Children are not small adults. They are injured in different ways and react differently to the injuries they sustain. The results of this project have indicated a need for further refinement of the pediatric triage tools available to nurses in EDs, with a focus on early identification of patients at risk for serious head injury.

Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleWhat You See is Not (Necessarily) What You Get: A Retrospective Chart Review of Pediatric Head Injuriesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/198356-
dc.description.abstract[ENA Annual Conference 2011 - Research Presentation]What You See is Not (Necessarily) What You Get: A Retrospective Chart Review of Pediatric Head Injuries<br/><br/>Purpose: The triage nurse is the first stop for most ED patients. It is the burden of the ED triage nurse to identify those children who may be at risk for a head injury which could require medical or neurosurgical intervention. The assessment of pediatric head injuries is especially challenging, even for the experienced triage nurse, because “signs and symptoms of head injuries in children to not correlate well with the risk of intracranial injuries.” At present, no nursing triage tool specific to pediatric head injuries exists. The purpose of this study was to identify the subjective and objective clinical findings which are highly associated with serious head injury in children aged newborn through seventeen. <br/><br/>Design: A staff nurse in a children’s emergency department (CED) conducted a retrospective chart review of 100 CED patients aged newborn to 17 from 2005 - 2009 with a final diagnosis of skull fracture and/or intracranial hemorrhage. Specific focus was given to the data received (by patient assessment and parent report) at triage. <br/><br/>Setting: The CED is part of a teaching, urban, level one trauma center in a capital city of the southern United States that sees appx 42,000 patients per year.<br/><br/>Participants/Subjects: IRB expedited approval was received for this study. The inclusion criteria for the retrospective chart review was all CED patients who were seen between 6/24/2005 – 12/31/2009 and who had a final diagnosis of skull fracture and/or intracranial hemorrhage (by radiographic study). Exclusion criteria included patients brought in as Trauma Ones, as well as patients with pre-existing conditions which increased their chance of sustaining a serious head injury.<br/><br/>Methods: Non-identifying information for each enrolled patient was recorded on a data collection form. Information included but was not limited to: age, mechanism of injury, location of injury, signs and symptoms present at triage, radiographic study findings, and final patient disposition. Results were combined and analyzed in order to identify commonalities that could be reported. <br/><br/>Results/Outcomes: The temporal-parietal region was the most frequent site of serious head injury, with a 60% (N=60) rate of injury. Several mechanisms of injury were more likely to result in a serious head injury, including falls out of shopping carts and infants who were dropped or fell. 44% (N=44) of the serious head injuries were in children under 2 years of age. Only 15% (N=15) of the children with serious head injuries had a positive LOC reported following their injury. Most alarming was that 32% (N=32) of children with a serious head injury showed no symptoms at all other than a hematoma. <br/><br/>Implications: Children are not small adults. They are injured in different ways and react differently to the injuries they sustain. The results of this project have indicated a need for further refinement of the pediatric triage tools available to nurses in EDs, with a focus on early identification of patients at risk for serious head injury.<br/><br/>en_GB
dc.date.available2011-12-21T12:47:12Z-
dc.date.issued2011-12-21T12:47:12Z-
dc.date.accessioned2011-12-21T12:47:12Z-
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