Minor traumatic head injuries in children How to improve management?

Minor traumatic head injury (MTHI) is a very common problem among children with a low risk of short-term serious complications. However, if complications arise, they can lead to great morbidity and mortality and therefore they might not be missed. To guide clinicians in the decision which management should be taken in the emergency department – a head CT scan, clinical observation, or discharge - in a child with MTHI the Dutch national MTHI guidelines was developed in 2010. This thesis describes the knowledge quality cycle regarding these national guidelines.
First, we evaluated the implementation and evaluation of the guidelines and stated that implementation was lacking, and large clinical variety existed between clinicians and hospitals. We showed that clinicians did not adhere to the guidelines, and they would like to see a revised and more uniform guidelines. Furthermore, we demonstrated that head CT rate was redundantly raised instead of lowered after publishing the guidelines, and that clinicians would rather observe a child than make a head CT scan when they were left a choice. This could have implication for health care resources and costs. Next, we extracted current knowledge gaps of the MTHI guidelines. Subsequently, we showed that using the largest international guidelines – the PECARN guidelines - is safe for the national population. Using all the information from the knowledge quality cycle, we reflected on some future perspectives and made a suggestion to improve national MTHI guidelines in children in the Netherlands.