RESUMEN
INTRODUCTION: Mild traumatic brain injury is a common condition in childhood. Although classified as mild, post-concussive symptoms may persist and interfere with daily activities. Because no established guidelines exist with respect to follow-up medical care for these children, there may be a delay in receiving appropriate care. We developed a follow up program to screen for persistent symptoms and if necessary, refer patients for further medical assistance. METHODS: From July 2010 until December 2013, eligible children aged 4-18 years who presented after sustaining a mild traumatic brain injury were included. All patients received a phone call after 6 weeks. After a period of 3 months, both their schoolteacher and parents were asked to complete in a questionnaire. The results were discussed monthly by a multidisciplinary team. RESULTS: A total of 305 children were enrolled in our follow-up program. Headache was the most common acute symptom upon presentation (63%). Overall, 19% of all patients had problems, either at 6 weeks or 3 months. 14% of these patients were referred for special care. Most common persistent post-concussive symptoms were headache (32%), cognitive problems (23%) and behavioural problems (16%). After a period of two years, a review of patient charts revealed that all of the problems were resolved. CONCLUSION: One fifth of the children exhibit post-concussive symptoms after mild traumatic brain injury. Education of patients and caregivers and a follow up visit if needed applied appropriate care at an early stage to minimise physical and mental problems.
Asunto(s)
Conmoción Encefálica/complicaciones , Conmoción Encefálica/psicología , Adolescente , Conmoción Encefálica/rehabilitación , Niño , Preescolar , Disfunción Cognitiva/complicaciones , Disfunción Cognitiva/prevención & control , Disfunción Cognitiva/psicología , Femenino , Estudios de Seguimiento , Cefalea/complicaciones , Cefalea/psicología , Humanos , Masculino , Problema de Conducta/psicología , Factores de TiempoRESUMEN
BACKGROUND: Large numbers of claim files present a potentially valuable source of information to get insight on possibilities for prevention of claims. Therefore, the feasibility of root cause analyses on incidents leading to liability claims at The Netherlands' largest medical liability insurer was assessed. METHODS: Feasibility was defined by validity, reliability and applicability. Claim files from diagnostic errors in emergency departments of Dutch hospitals were selected. All closed and settled claim files from the year 2001 and 2002 were used. RESULTS: Fifty incidents occurring at 31 emergency departments were found in 47 files. 114 root causes were found, on average 2.3 per incident. 78% of the incidents were related to missed fractures, luxations or tendon lesions. Zero technical, 29% organisational, 66.7% human-related and 4.4% patient-related factor errors were found. Inter-rater agreement for classification of root causes was good (κ = 0.78). Preventive measures following from Prevention and Recovery Information System for Monitoring and Analysis (PRISMA) classification-action matrix were improving completion of available sources of information, improving structures of communication and training staff to prevent failures due to the wrong implementation of tasks or due to errors in reasoning. DISCUSSION: Validity of the root cause profile of diagnostic claims is considered moderate because of a lack of information about technical and organisational causes of errors. Therefore, the root cause profile was incomplete for organisational factors in comparison with other studies. However, with regard to the diagnostic reasoning process, the profile was stable. The feasibility of PRISMA for retrospective analyses of closed claims may be improved if system-based reasoning by the liability insurer and hospital staff is enhanced.