Supporting Emergency Department Providers in Recognizing Abusive Head Trauma

Abstract

Background: Abusive head trauma (AHT) remains the leading cause of child abuse deaths in the United States, with approximately 1,300 cases each year (National Center on Shaken Baby Syndrome, 2018). Injuries from AHT can be severe and life threatening, and can include subdural hematomas, subarachnoid hemorrhage, retinal hemorrhage, intercranial hypertension, and spinal cord and/or diffuse axonal injury (Cabrera & Schub, 2017). AHT primarily occurs in children under the age of two years, with most victims under the age of six months; however, AHT can be diagnosed in children up to age five years old (Cabrera & Schub, 2017). Emergency department providers are one group of medical providers who are likely to encounter physical abuse in children. Therefore, they must be prepared to recognize the many manifestations abuse may come in (Tiyyagura, Beucher, & Bechtel, 2017).

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to educate emergency department providers in recognizing the signs and symptoms of AHT in infants and children. Methods: This DNP project utilized a one group, pre-test/post-test design to compare if provider knowledge about abusive head trauma increased after an evidence-based education on recognizing signs and symptoms in infants and children in emergency department providers. Participants were recruited from the staff in the pediatric emergency department at Providence Sacred Heart Children’s Hospital in Spokane, WA through convenience sampling. The project utilized the Pediatric Abusive Head Trauma course provided by Wild Iris Medical Education, which is designed to enable healthcare providers to recognize and prevent pediatric AHT (Cox, 2016). Results: Overall, results revealed that emergency department provider (n=8) knowledge about abusive head trauma did not significantly improve after the educational intervention (p=0.260) with a mean score of 86.78% on the pre-test, and a mean score of 91.66% on the post-test. Discussion: The results of this study were consistent with the current evidence that emergency department providers do not get enough education on abusive head trauma. Although the results were not statistically significant, this could be due to the study focusing on a pediatric emergency department and not on a generalized emergency department. Future research is warranted to determine if the results would be different when not presented to a department that specializes in children.