Professional practice assessment for minor head injury management in emergency department and clinical impact of a simulation-based training: interventional study (before/after) [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-91589 | DOI: 10.14744/tjtes.2020.91589  

Professional practice assessment for minor head injury management in emergency department and clinical impact of a simulation-based training: interventional study (before/after)

Pierre Vandingenen1, Anthony Chauvin2, Nicolas Javaud3, Daniel Aiham Ghazali4
1Emergency Department and EMS, University Hospital of Poitiers, Poitiers, France
2Emergency Department and EMS, University Hospital of Lariboisière, Paris, France
3Emergency Department, University Hospital of Louis Mourier, Colombes, France
4Emergency Department and EMS, University Hospital of Bichat, Paris, France

Background: Minor head injury is a frequent reason for consultation in emergency department (ED). The use of CT has increased dramatically in patients’ care. Good time management implementation and interpretation is required.
Objectives: To study the level of agreement with recommendations for minor head injury in emergency department (ED) management and the impact of a simulation-based training (SBT) on professional practice changes.
Methods: Evaluation of professional practice for patient care in an ED according to the recommendations of the French Emergency Medicine Society (SFMU) established in 2012 before and after a SBT including a theoretical and simulation courses. It was based on the analysis of time to carry out CT scan. It was also based on analysis of adherence to brain and spine scan indications, and to hospitalization criteria.
Results: The SBT carried out in the evaluation of the professional practices makes it possible to acquire the notion of urgency to obtain the CT Scan within one hour when the criteria are met (p=0.007). Rater reliability for agreement with the hospitalization recommendations was better after SBT (p=0.03, increased Kappa from 0.73 to 0.93). On the other hand, there appeared to be a lack of essential information in the medical file, such as time of onset of head trauma.
Conclusions: Management of this type of patient appeared to be satisfactory. It can be improved by SBT on the basis of the SFMU 2012 consensus conference. There is a need to improve the software used by the emergency departments, which should include time of trauma and recommendations. The association of the clinic and the biomarkers could help to limit the indications of CT scan, and thus to have it organized more rapidly.

Keywords: Minor head injury, Evaluation of professional practice, CT scan, cervical spine, hospitalization, Emergency Medicine.




Corresponding Author: Daniel Aiham Ghazali, France


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