Shared Decision Making in Parents of Children With Head Trauma: Head CT Choice
Shared Decision Making in Parents of Children With Head Trauma: Head CT Choice
The investigators will test the impact of a decision aid, Head CT Choice, to determine if its
 use improves parents' knowledge and engagement in decision making and safely decreases
 healthcare utilization in children presenting to the emergency department with blunt head
 trauma.
The investigators' long term goal is to promote evidence-based, patient-centered evaluation
 in the acute setting, to more closely tailor testing to disease risk. The investigators will
 compare the use of risk stratification tools with usual clinical approaches to treatment
 selection or administration through the following aim:

 Test if the decision aid, Head CT Choice, improves validated patient-centered outcome
 measures and safely decreases healthcare utilization. The investigators will randomize at the
 clinician level. Through the use of the intervention, Head CT Choice, the investigators aim
 to significantly increase parents' knowledge, engagement, and satisfaction, decrease the rate
 of head CT use, and decrease 7-day total healthcare utilization, with no significant increase
 in adverse events.
Inclusion Criteria:

 Parents and their child, seeking care for a child who:

 1. Is < 18 years of age;

 2. Had blunt trauma above the eyebrows (not isolated to face or eyes);

 3. Is positive for at least 1 of the PECARN clinical prediction rule predictors described
 below:

 PECARN Predictors for children < 2 years of age:

 Severe mechanism (PECARN definition)* Loss of consciousness > 5 seconds Acting abnormally
 per parent Initial ED GCS < 15 by attending (or CT decision-maker) Other signs of altered
 mental status (PECARN definition) Presence of occipital, temporal or parietal scalp
 hematoma Palpable skull fracture or unclear if skull fracture

 PECARN predictors for children 2-18 years of age:

 Severe mechanism (PECARN definition)* Any loss of consciousness Any vomiting since the
 injury Severe headache in ED Initial ED GCS < 15 by attending (or CT decision-maker) Other
 signs of altered mental status (PECARN definition)** Any sign of basilar skull fracture
 Clinicians include attending physicians and fellows or midlevel providers caring for
 children with head trauma

 Exclusion Criteria:

 Parents of children with:

 1. GCS scores < 15

 2. Evidence of penetrating trauma, signs of basilar skull fracture, or depressed skull
 fracture on physical examination

 3. Brain tumors

 4. Ventricular shunts

 5. Bleeding disorder

 6. Pre-existing neurological disorders complicating assessment

 7. Neuroimaging at an outside hospital before transfer

 8. Signs of altered mental status (agitation, somnolence, repetitive questioning, or slow
 response to verbal communication)

 9. Syncope or seizure disorder preceded (led to) head trauma or seizure post head trauma

 10. Known to be pregnant

 11. Communication barriers such as visual or hearing impairment that may preclude use of
 the decision aid.

 12. Strong suspicion of abuse for this head injury