RECOVER Clinical Pathway for Pediatric Concussion
Condition: Concussion, Brain; Pediatric Disorder; Mild Traumatic Brain Injury
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Brain Concussion
Study type: Interventional

Summary: 
      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).
    

Detailed description: 
      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:

        1. Design an evidence-based, knowledge-user informed, and theory-driven approach to
           implementation of a clinical pathway for acute care of pediatric concussion. Guided by
           the Theoretical Domains Framework (TDF), the investigators will assess barriers and
           facilitators likely to influence uptake of the CP in acute care settings. The results of
           that assessment will inform implementation strategy design, again guided by the TDF.

        2. Evaluate the impact of the implementation of the CP on patient-centered outcomes using a
           stepped wedge cluster randomised trial. Within the context of a stepped wedge cluster
           randomised trial, the investigators will assess relevant process and clinical outcomes
           to determine whether implementation of the CP results in significant uptake of the
           pathway, as well as higher patient satisfaction and better health outcomes following
           concussion.

        3. Determine whether the implementation and use of a CP for acute care of pediatric
           concussion is associated with changes in health care utilization and associated costs.
           Health care utilization and costs associated with care of concussion will be compared
           before and after the implementation of the CP. Utilization and costs are expected to
           remain stable or decline following implementation of the CP.
    

Intervention name(s): Pediatric Acute Care Concussion Clinical Pathway
Intervention type(s): Other
Intervention description(s): 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.
Intervention model: Single Group Assignment
Intervention model description: 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.
Masking: None (Open Label)
Primary purpose: Health Services Research