Knowledge Content Library
A DA on the Use of Anti-coagulants for Children with Traumatic Brain Injuries (TBI) or "I Really Hate Bleeding!"
Rob Kleinbaum, RAK & Co. and Ian Mutchnick, Korsair Children's Hospital
Protocols for using anti-coagulants for adults with TBI are well established but there is still no consensus on the decision rules for children. The trade-off is the risk of a blood clot versus the risk of uncontrolled bleeding in the cranial cavity. We use decision analysis to shed insight on the risk/reward profiles of the different choices. But the interesting story here is not the treatment decision, but how hidden assumptions and fears affect doctor’s decisions and perceptions of risks. Another issue is that trauma surgeons, who take the lead in developing the protocols, and neurosurgeons, who bear the costs if something goes wrong, have different perspectives on the relative risks. These have important implications for physician acceptance of change and innovation. For decision consultants, it is a powerful example of how proper framing requires different approaches than are typically used.
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Keywords: framing framestruc