Traumatic brain injury (TBI) is a significant problem in the pediatric population. Ninety per cent of pediatric TBIs present to an emergency department, but only 8% are hospitalized. Since the majority of pediatric patients with mild TBI are therefore discharged home with the diagnosis of concussion, accurate assessment of the severity if concussion and consequent outpatient management and instructions are critical for ensuring safe recovery from injury. Without state-of-the-art knowledge and clinical tools, mild TBI (mTBI) may go undiagnosed and untreated, leaving individuals who have sustained a mTBI with an increased risk for functional problems. The ACE and ACE care plan were developed as part of the CDC's """"""""Heads Up: Brain Injury in your Practice"""""""" toolkit for physicians to manage mTBI. Adapting the ACE for the ED and implementing a standardized clinical protocol by ED physicians systematically should improve management by ensuring accurate diagnosis and improving patient education and adherence with discharge recommendations. The goal of this research is to demonstrate the capacity to improve diagnosis and management of mTBI presenting to the Emergency Department (ED) by the feasible application of systematic procedures in the form of the ACE and the ACE Care Plan. This study will be conducted collaboratively by Children's National Medical Center and UPMC/ Children's Hospital of Pittsburgh with the specific aims to: (1) evaluate the feasibility of the ACE and ACE Care Plan for standardized implementation in the ED setting (2) determine if the ACE and ACE-ED Care Plan can be implemented by the ED staff and disseminated to the Primary Care Providers and (3) determine if routine use of the ACE-ED and ACE-ED Care Plan will improve patient/family follow-up behavior and patient recovery. We have designed the study to progress in two stages: Stage 1 proposes to develop expert consensus agreement regarding the importance and feasibility of using the ACE and ACE Care Plan in the ED setting, including an understanding of current concussion management care pathways. An outcome of Stage 1 will be the consensus-based adaptation of the ACE and ACE Care Plan for the ED, referred to as the ACE-ED and the ACE-ED Care Plan. Stage 2 applies these revised tools via a pilot implementation study for patients age 5-22 years old presenting with mTBI. The primary outcome will be patient/family follow-up behavior with the primary care/specialist. As secondary outcomes, we will examine clinician adherence to use of the ACE-ED and ACE-ED Care Plan, and its dissemination to primary care providers. Feasibility of implementation will be further evaluated by identifying the actual facilitative and barrier conditions to ACE-ED/ Care Plan use within the ED setting. We will also develop estimates of effect of this implementation on patient recovery. Upon study completion, key data will be available to support the development of

Public Health Relevance

Mild Traumatic Brain Injury (mTBI) is a significant public health concern but the injury often goes unrecognized. The goal of this research is to demonstrate the capacity to improve management of mTBI presenting to the Emergency Department by the systematic application of the Acute Concussion Evaluation (ACE) and the ACE Care Plan. We will conduct a pilot implementation study that will provide important evidence for improving identification, diagnosis and management of mTBI in the ED setting.

National Institute of Health (NIH)
National Center for Injury Prevention and Control (NCIPC)
Coop: Injury Control Res. and Demo and Injury Prevention (U49)
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Special Emphasis Panel (ZCE1-FXR (02))
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Childress, Adele M
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Children's Research Institute
United States
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Gioia, Gerard A (2016) Medical-School Partnership in Guiding Return to School Following Mild Traumatic Brain Injury in Youth. J Child Neurol 31:93-108
Terwilliger, Virginia K; Pratson, Lincoln; Vaughan, Christopher G et al. (2016) Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes. J Neurotrauma 33:761-5
Zuckerbraun, Noel S; Atabaki, Shireen; Collins, Michael W et al. (2014) Use of modified acute concussion evaluation tools in the emergency department. Pediatrics 133:635-42
Tavarez, Melissa M; Atabaki, Shireen M; Teach, Stephen J (2012) Acute evaluation of pediatric patients with minor traumatic brain injury. Curr Opin Pediatr 24:307-13