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| Name | Class |
|---|---|
| Brain Canada | OTHER |
| Alberta Health services | OTHER |
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The project encompasses the development and implementation of an acute care, pediatric concussion clinical pathway at 5 pediatric emergency departments in the province of Alberta (Canada).
Clinical pathways (CPs) do not currently guide the care of children with concussions presenting to acute care settings in Alberta. The Alberta Health Services Maternal Newborn Child & Youth (MNCY) Strategic Clinical Network established a work group to develop best-practice, evidence-based Clinical Practice Guidelines for the management of concussion that are being translated into specific CPs for different clinical settings.
The research has three key objectives:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Clinical Pathway Participation | Other | Patients that are seen in an emergency department participating in the clinical pathway will not be aware of any changes, other than be given a specific education handout at discharge and be advised to visit the recoverconcussion.ca web portal. Specialty referrals for high risk patients will automatically be made during the emergency visit, through the clinical pathway. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Pediatric Acute Care Concussion Clinical Pathway | Other | MD assessment will be partially standardized to assess for patients at higher risk of becoming persistently symptomatic. These patients scoring as 'high risk' will be referred to one of three specialty clinics. High risk is defined as scoring 9 or higher out of 12 on the 5P score. |
| Measure | Description | Time Frame |
|---|---|---|
| Process Outcome | Measurement of clinician utilization of the newly implemented clinical pathway. Clinician utilization was represented by proportion of clinician-completed 5P assessments per diagnosed concussion. Data was also collected on the number of high risk referrals made through the clinical pathway and the number of handouts provided by the clinician to patients and families. | Through study enrollment (Jan 30 - Nov 30, 2019) 11 months |
| Clinical Outcome | Time to symptom resolution using weekly ratings by patients and parents of whether patient has returned to pre-injury status. Parents and children were asked asked to complete a numeric scale of 0 to 10 (where 0 is very bad and 10 is back to normal), how do you feel now? | Through study enrollment, plus a 6 follow-up period, 15 months |
| Measure | Description | Time Frame |
|---|---|---|
| Emergency Department satisfaction | Ratings of care received in the emergency department | Through study enrollment (Jan 30 - Nov 30, 2019) 11 months |
| RECOVER web portal usage | Number of unique website hits per IP address |
| Measure | Description | Time Frame |
|---|---|---|
| Health care utilization 1: Acute care length of stay | Duration of stay in the emergency department | Through study enrollment (Jan 30 - Nov 30, 2019) 11 months |
| Health care utilization 2: Return visits within 72 hours of discharge |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Keith Yeates, PhD | University of Calgary | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Calgary | Calgary | Alberta | T2N1N4 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33546684 | Background | Ly A, Zemek R, Wright B, Zwicker J, Schneider K, Mikrogianakis A, Conradi A, Johnson D, Clark B, Barlow K, Burey J, Kolstad A, Yeates KO. "What is the actual goal of the pathway?": examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework. BMC Health Serv Res. 2021 Feb 5;21(1):119. doi: 10.1186/s12913-021-06110-2. | |
| 37351798 |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Nov 10, 2021 | Feb 17, 2022 | Prot_001.pdf |
| ICF | No | No | Yes | Informed Consent Form | Jun 21, 2018 | Oct 13, 2021 | ICF_000.pdf |
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| ID | Term |
|---|---|
| D001924 | Brain Concussion |
| ID | Term |
|---|---|
| D000070642 | Brain Injuries, Traumatic |
| D001930 | Brain Injuries |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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The project will involve a stepped wedge time series design to evaluate the implementation of the Maternal Newborn and Child Health clinical pathway for the acute care of pediatric concussion.
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Each site will be randomized to a start date. Once a site starts the clinical pathway, the clinical pathway tools (assessment, education and referral tools) will be utilized by staff in that particular emergency department. Patients and parents will be unaware of clinical pathway.
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| 1 year |
| Adherence to discharge recommendations | Rate of patient and parent reported adherence to physician discharge instructions | Through study enrollment (Jan 30 - Nov 30, 2019) 11 months |
| Rate of diagnosed concussions | Rate of diagnosed concussions per visit (as noted by billing codes) | Through study enrollment (Jan 30 - Nov 30, 2019) 11 months |
| Rate of Head CT scans ordered | Rate of CT scans ordered per diagnosed concussion | Through study enrollment (Jan 30 - Nov 30, 2019) 11 months |
| Post-concussive symptom ratings | Child and parent symptoms ratings measured using the Health and Behaviour Inventory. Measured weekly from injury to resolution of symptoms. | Through study enrollment (Jan 30 - Nov 30, 2019) 11 months |
| Quality of life ratings | Child and parent quality of life ratings measured by the Pediatric Quality of Life Inventory | 4 weeks post injury |
Numbers of patients that returned back to the emergency department for a subsequent visit
| Within 72 hours of initial discharge from the emergency department |
| Health care utilization 3: Number of subsequent outpatient visits | Number of outpatient medical visits attended by patients | Within 3 months of initial discharge from the emergency department |
| Health care costs | Cost of emergency department visit(s) and subsequent outpatient visits as determined by administrative data | Through study enrollment, plus a 3 follow-up period, 14 months |
| Derived |
| Yeates KO, Barlow KM, Wright B, Tang K, Barrett O, Berdusco E, Black AM, Clark B, Conradi A, Godfrey H, Kolstad AT, Ly A, Mikrogianakis A, Purser R, Schneider K, Stang AS, Zemek R, Zwicker JD, Johnson DW. Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial. CJEM. 2023 Jul;25(7):627-636. doi: 10.1007/s43678-023-00530-1. Epub 2023 Jun 23. |
| D009422 | Nervous System Diseases |
| D006259 | Craniocerebral Trauma |
| D020196 | Trauma, Nervous System |
| D016489 | Head Injuries, Closed |
| D014947 | Wounds and Injuries |
| D014949 | Wounds, Nonpenetrating |