The Australasian Paediatric Head Injury Rules Study: Assessing the gap prior to implementation (APHIRST Gap). A mixed methods study examining the use of CT scanning of the brain in the management of children admitted to the Emergency Department with a head injury.

This study utilises a mixed method study design. Quantitative study: Sites will conduct a retrospective medical record audit of children admitted to their Emergency Department (ED) between January 1 and December 31, 2016 with a presenting diagnosis of head injury. Data from the first 100 eligible patients will be collected on the use of CT scanning of the brain (CTB) to confirm their diagnosis at discharge, with the objective of identifying hospital and or patient level factors associated with CTB use. We are specifically looking at the variation of CTB use between tertiary, urban and rural/regional hospitals located in Australia and New Zealand. Each site will conduct a medical record search for admissions to their ED with a diagnosis of head injury. Each record will be screened for eligibility, with data collected from the first 100 eligible records only. Data will be directly entered into a secure web-based database. Qualitative study: Interviews will be conducted with clinical staff at participating EDs with various levels of training and expertise to identify and explore the clinician and organisational related factors influencing the use of CTB in children with mild head injuries, We are interested in identifying the resources available and used by clinicians in EDs to inform their management of mild head injuries. Potential participants will be provided with an Information Statement and participation in the interview will be considered as implied consent. Interviews will be recorded, transcribed and qualitatively analysed using the Theoretical Domains Framework (TDF).