Emergency Physicians’ Approach to Minor Head Trauma in Pediatric Patients

Abstract

Objectives: To investigate the use of tomography in children with head trauma by emergency department physicians, the frequency of their applying clinical decision-making rules (CDMRs), and the factors playing a role in the decision of tomography use. Materials and Methods: Our 19 question-survey was applied to physicians working in different statuses in the emergency departments of various hospitals in our country. Results: Three hundred and six physicians participated in our study. The rate of tomography use in pediatric patients with minor head trauma was reported by physicians as follows: One hundred and three physicians stated as 10% or less, 60 as between 11% and 25%, 39 as between 26% and 50%, and 104 as 50% or more. 39.5% of the participants stated that they applied CDMRs when making a computed tomography (CT) decision, 42.8% stated that they decided according to their clinical experience, 6.2% stated that they made the decision with the recommendation of a consultant. 36.6% of the physicians stated that they were threatened and insulted for not performing a CT scan and 6.9% stated that they were subjected to verbal and physical attacks. The reason for the increase in tomography use was defined as the fear of malpractice by 56.2%, family pressure by 22.2% and desire to conclude the patients quickly in a busy working environment by 8.2% participants. Conclusion: It was observed that the rate of application of CDMRs by physicians was low and the rate of tomography use was high. Medico-legal concerns, the pressure of families, and patient overcrowdedness in the emergency room took the top three places among the reasons for this.

Keywords

• Emergency Department
• Computerized Tomography
• Pediatric Head Trauma
• Clinical Decision-Making Rules

Acil Serviste Görev Yapan Hekimlerin Minör Kafa Travmalı Çocuk Hastalara Yaklaşımı

Abstract

Amaç: Bu çalışmada acil servis hekimlerinin kafa travmalı çocuk hastalardaki tomografi kullanımlarını, klinik karar verme kurallarını (KKK) ne kadar uyguladıklarını ve tomografi kullanım kararının verilmesinde rol oynayan etmenleri araştırmayı amaçladık. Gereç ve Yöntem: Ülkemizdeki çeşitli hastanelerin acil servislerinde farklı statülerde görev yapan hekimlere 19 soruluk anketimiz uygulandı. Bulgular: Çalışmamıza 306 hekim katıldı. Minör kafa travmalı çocuk hastalardaki tomografi kullanım oranlarını hekimlerin 103’ü %10 ve altında, 60’ı %11-25 arasında, 39’u %26-50 arasında ve 104’ü %50 ve üzerinde olarak belirtti. Katılımcıların %39,5’i bilgisayarlı tomografi (BT) kararı verirken KKK’yi uyguladığını, %42,8’i kendi klinik tecrübelerine göre, %6,2’si konsültan önerisiyle karar verdiğini belirtti. Hekimlerin %36,6’sı BT çekmediği için tehdit ve hakarete uğradığını, %6,9’u sözlü ve fiziksel saldırıya maruz kaldığını ifade etti. Tomografi kullanımındaki artışın nedenini katılımcıların %56,2’si malpraktis korkusu, %22,2’si aile baskısı, %8,2’si yoğun çalışma ortamında hastayı hızlı sonuçlandırma olarak tanımladı. Sonuç: Hekimlerin KKK’yi uygulama oranlarının düşük ve tomografi çekme oranlarının yüksek olduğu izlenmiştir. Bunun nedenleri arasında medikolegal endişeler, ailelerin baskısı ve acil servisteki hasta yoğunluğu ilk üç sırayı almıştır.

Keywords

• Acil Servis
• Bilgisayarlı Tomografi
• Çocuk Kafa Travması
• Klinik Karar Verme Kuralları

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