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Table 2 Clinical practice and patient outcomes

From: Evaluation of a targeted, theory-informed implementation intervention designed to increase uptake of emergency management recommendations regarding adult patients with mild traumatic brain injury: results of the NET cluster randomised trial

Outcome Definition of outcome measure Potential range of responses/interpretation of scales Outcome assessment period/timing Data collection method
Clinical practice outcomes (measured on all patients)
 Outcomes measuring the implementation of single clinical recommendations
  Appropriate post-traumatic amnesia screening (PTA)* Prospective assessment of PTA appropriately undertaken, where appropriately undertaken was defined as using a validated tool, until a perfect score was achieved (indicating absence of acute cognitive impairment) before the patient was discharged home (or the patient was admitted or transferred) Yes or no Retrospectively on 2 month period post-intervention Chart audit
  PTA screening-tool The administration of the validated tool was completed at least once Yes or no Retrospectively on 2 month period post-intervention Chart audit
  Memory-clinical assessment Clinicians had made an assessment of PTA using questions in their clinical assessment Yes or no Retrospectively on 2 month period post-intervention Chart audit
  CT scan-clinical criteria (CT) A CT scan was provided in the presence of a risk factor that justified the scan (age 65 or older; GCS < 15; amnesia; suspected skull fracture; vomiting and coagulopathy) [25] (assessed in the cohort of patients for whom risk criteria were recorded only) Yes or no Retrospectively on 2 month period post-intervention Chart audit
  CT scan (all) & A CT scan was provided or not Yes or no Retrospectively on 2 month period post-intervention Chart audit
  Provision of written patient information (INFO) Written information was provided to the patient on discharge home from the ED Yes or no Retrospectively on 2 month period post-intervention Chart audit
 Outcomes measuring the implementation of composite recommendations
  Safe discharge based on PTA and INFO Safe discharge based on whether the patient received appropriate care for the two practices PTA and INFO (assessed for all patients) Yes or no Retrospectively on 2 month period post-intervention Chart audit
  Safe discharge based on PTA, CT, and INFO Safe discharge based on whether the patient received appropriate care for all of the three clinical practices PTA, CT, and INFO (assessed in the cohort of patients for whom risk criteria were recorded) Yes or no Retrospectively on 2 month period post-intervention Chart audit
Patient outcomes (measured on NET-Plus only patients)
  Anxiety All 7 anxiety items from the Hospital Anxiety and Depression Scale [70, 71]. Each item is rated on a 4-point scale from 0 to 3, with 3 indicating higher symptom frequency. The scores were summed across the 7 items to create an anxiety score Score between 0 and 21, with higher scores indicating greater anxiety. (A score > 7 indicates clinically significant anxiety) 3 to 5-month post-discharge# Patient telephone interview
  Post-concussion symptoms (RPQ-13) 13 item Rivermead scale (RPQ-13) [72]. Each item measured on a 5-point scale from 0 (not experienced) to 4 (severe problem). The scores were summed across the 13 items to create the RPQ-13 score Score between 0 and 52, higher scores indicate greater severity of post-concussion symptoms. 3 to 5-month post-discharge Patient telephone interview
  Post-concussion symptoms (RPQ-3)& 3 item Rivermead scale (RPQ-3) [72]. Each item measured on a 5-point scale from 0 (not experienced) to 4 (severe problem). The scores were summed across the 3 items to create the RPQ-3 score. Score between 0 and 12, higher scores indicate greater severity of post-concussion symptoms 3 to 5 month post-discharge Patient telephone interview
  Not returned to normal activities Based on three items: (1) whether the patient was doing the same working hours as before the incident (if applicable), (2) whether the patient was studying the same hours as before the incident (if applicable), and (3) whether the patient was back to their other normal activities such as gardening, buying groceries, visiting friends or family, or other leisure activities. Each item was coded ‘No’ or ‘Yes’. The three items were then combined; if one of these items was scored ‘no’, the patient was considered to have not returned to normal activities. No or Yes. ‘Yes’ means the patient has not returned to normal activities. 3 to 5-month post-discharge Patient telephone interview
  Health-related quality of life (SF6D) SF6D index scores, derived from 12-item short form health survey (SF-12) [73, 74]. Scores between 0.350 (the ‘pits’) and 1.000 (‘full health’), higher scores indicate higher HRQoL. 3 to 5-month post-discharge Patient telephone interview
  mTBI-related re-presentation$ The patient re-presented within a month of the initial presentation for an mTBI-related reason Yes or no Retrospectively on 2 month period post-intervention Chart audit
  1. *Primary outcome
  2. #Patient interviews took place between 4.3 and 10.7 months post-presentation. Reasons for the difference between planned and actual patient follow-up are outlined in Additional file 2
  3. $Chart audit data
  4. &Outcome additional to trial protocol. Reasons for inclusion outlined in Additional file 2