Abstract:
Aim: To examine the occurrence of traumatic brain injury (TBI) among New Zealand children and to investigate the quality of healthcare delivered in the emergency department (ED) setting to children with mild TBI. Methods: A systematic review of the literature regarding the occurrence of TBI among New Zealand children was undertaken alongside a clinical audit examining the quality of healthcare delivered to children with mild TBI who were discharged home after assessment in a children's hospital ED in 2007. Medical records of a random sample of 60 children aged <15 years stratified by ethnicity and age were reviewed. ED processes of care for mild TBI were compared with best practice standards derived from guideline recommendations. Findings: The systematic literature review revealed important gaps in knowledge regarding the burden of mild TBI among New Zealand children. The clinical audit identified that processes of care designed to manage potentially life-threatening acute complications (e.g. selection of children for CT scanning to identify intracranial haemorrhage) were consistent with best practice standards. However gaps existed between current and best practice for aspects of care that could minimise risks of disability. For example, despite a high standard of documentation of data required for estimating the probability of TBI, this information was not applied to clearly identify children with definite or possible TBI. In addition, documentation deficiencies raised concerns regarding whether information is provided in a manner supportive of the cultures and languages of families/wh?nau, missed opportunities for injury prevention advice, and the adequacy of follow-up plans in the community. Conclusion: The identified gaps in research knowledge and quality of care in the ED setting require attention to develop effective integrated services that minimise the risk of disability following childhood TBI.