Table 2:
Respondent opinions and management preferences regarding the clinical vignette involving a 7-year-old girl, Glasgow Coma Scale score 15, with a 5-mm subdural hematoma after a fall down the stairs. Responses either involved selecting all appropriate choices or a Likert-scale ranging from Strongly Disagree (1 point) to Strongly Agree (5 points).
| All* | Admit Floor* | Admit ICU* | P-Value** | |
|---|---|---|---|---|
| Appropriate Consults, n (%) | NA | |||
| Critical Care | 124 (23.1) | 5 (2.4) | 119 (36.5) | |
| General Surgery | 327 (61.0) | 100 (48.1) | 227 (69.6) | |
| Neurosurgery | 532 (99.3) | 205 (98.6) | 325 (99.7) | |
| Pediatrics | 15 (2.8) | 8 (3.9) | 7 (2.2) | |
| Other | 2 (0.37) | 1 (0.48) | 1 (0.31) | |
| No consult indicated | 1 (0.19) | 0 (0) | 1 (0.31) | |
| How would you characterize the injury, n, (%) | NA | |||
| Mild TBI | 69 (12.9) | 30 (14.4) | 39 (12.0) | |
| Complicated mild TBI | 138 (25.8) | 59 (28.4) | 79 (24.4) | |
| GCS 13–15 head injury with intracranial injury | 317 (59.4) | 127 (61.1) | 189 (58.3) | |
| Moderate TBI | 150 (28.1) | 56 (26.9) | 93 (28.7) | |
| Severe TBI | 17 (3.2) | 1 (0.48) | 16 (4.0) | |
| Important to involve family in my decision regarding the appropriate level of care, mean (Stdev) | 3.98 (1.03) | 4.11 (0.94) | 3.90 (1.08) | 0.02 |
| This child is likely to undergo neurological decline, mean (Stdev) | 2.56 (0.80) | 2.31 (0.69) | 2.71 (0.83) | < 0.01 |
| I am confident in my assessment of the risk of neurological decline, mean (Stdev) | 3.85 (0.70) | 3.82 (0.71) | 3.88 (0.69) | 0.33 |
| Before discharge I would order a repeat CT scan, | 2.59 (1.23) | 2.27 (1.04) | 2.79 (1.30) | < 0.01 |
| Before discharge I would order a follow-up MRI scan, mean (Stdev) | 2.41 (1.10) | 2.17 (0.97) | 2.56 (1.16) | < 0.01 |
| Before discharge I would order repeat CT and/or MRI (Strongly Agree/Agree), n (%) | 243 (45.4) | 55 (26.4) | 187 (57.5) | < 0.01 |
| Repeat neuroimaging is likely to influence my clinical management, mean (stdev) | 2.36 (0.89) | 2.14 (0.75) | 2.49 (0.94) | < 0.01 |
| Within 2 weeks of discharge, this child should have a follow-up appointment with, n (%) | NA | |||
| A neurosurgeon | 478 (89.2) | 185 (88.9) | 291 (89.3) | |
| A trauma surgeon | 22 (4.1) | 6 (2.9) | 16 (4.9) | |
| Her primary care physician | 364 (67.9) | 136 (65.4) | 228 (69.9) | |
| A neurologist | 52 (9.7) | 9 (4.3) | 43 (13.2) | |
| Other | 43 (8.0) | 10 (4.8) | 33 (10.1) |
Discrepancies in column totals reflect the small amount of missing data for injury characterization (n=2), need for repeat CT (n=3), need for follow-up MRI (n=4), and influence of repeat neuroimaging (n=1).
P-values refer to the univariate logistic regression predicting the level-of-care decision (floor vs. ICU) for the child in the clinical vignette. “NA” indicates not applicable, meaning the variable was not tested as a potentially clinically informative predictor.