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J Korean Soc Emerg Med > Volume 27(2); 2016 > Article
Journal of The Korean Society of Emergency Medicine 2016;27(2): 189-198.
Change in Guardians’ Favor in Computed Tomography after Explained by Emergency Physicians in Pediatric Head Injury
Jin Hee Jeong1, Jin Hee Lee2,3, Kyuseok Kim4, Joong Eui Rhee5, Tae Yun Kim4, You Hwan Jo4, Yu Jin Kim4, Jae Hyuk Lee4, Changwoo Kang1, Soo Hoon Lee1, Joonghee Kim4, Chan Jong Park6, Hyuksool Kwon4
1Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju-si, Gyeongsangnam-do, Republic of Korea
2Seoul National University Hospital, Seoul College of Medicine, Seoul, Republic of Korea
3Kangwon National University School of Medicine, Chuncheon, Republic of Korea
4Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
5Samsung Medical Center, Seoul, Republic of Korea
6Bohun Jungang Hospital, Seoul, Republic of Korea
Correspondence  Jin Hee Lee ,Tel: 02) 2072-4910, Fax: 02) 741-7855, Email: gienee@snuh.org,
Received: January 27, 2016; Revised: January 29, 2016   Accepted: February 17, 2016.  Published online: April 30, 2016.
ABSTRACT
Purpose:
Head injury in children is a common problem presenting to emergency departments, and cranial computed tomography scan is the diagnostic standard for these patients. Several decision rules are used to determine whether computed tomography scans should be used; however, the use of computed tomography scans is often influenced by guardian favor toward the scans. The objective of this study was to identify changes in guardian favor for explanation of minor head injuries based on the institutional clinical practice guidelines.
Method:
A survey was conducted between July 2010 and June 2012. Patients younger than 16 years with a Glasgow Coma Scale score of 15 after a head injury and guardians of these patients were included. Pre- and post-explanation questionnaires were administered to guardians to evaluate their favor for computed tomography scans and factors related to the degree of favor. Treating physicians explained the risks and benefits of cranial computed tomography scans using the institutional clinical practice guidelines. Guardian favor for a computed tomography (CT) scan was examined using a 100-mm visual analog scale.
Results:
A total of 208 patients and their guardians were included in this survey. Guardian favor for computed tomography scans was significantly reduced after explanation (46.7 vs. 17.4, p<0.01). Pre-explanation favor and the degree of physician recommending computed tomography were the most important factors affecting pre- and post-explanation changes in favor.
Conclusion:
Explanation of the risks and benefits of cranial computed tomography scans using the institutional clinical practice guidelines may significantly reduce guardian favor for computed tomography scans.
Key words: Head injury, Close, Pediatrics, Tomography, X-ray computed
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