Pediatric Trauma Society

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Pediatric PAUSE does not Prolong ED Stay for Most Patients Undergoing Trauma Evaluation
Sarah B Bingham, Brendin R Beaulieu-Jones, Maia S Rutman, *Reto M. Baertschiger
Dartmouth Hitchcock Medical Center, Lebanon, NH

BACKGROUND
With the goal of minimizing pain, anxiety, and unnecessary interventions during trauma evaluations in stable pediatric patients, we implemented the Pediatric PAUSE© at our Level 1 Adult/Level 2 Pediatric trauma center. The PAUSE is a brief protocol performed after the primary survey during which Pain/Privacy, Anxiety/IV Access, Urinary Catheter/Rectal exam/Genital exam, Support from family or staff, Explain to patient/Engage with PICU team are addressed. The aim of our study was to investigate retrospectively whether performing the PAUSE prolonged ED stay for pediatric trauma patients.
METHODS
We queried our hospital’s trauma database for all patients ages 0-18 evaluated as trauma activations during the time period after Pediatric PAUSE was implemented (10/1/16-3/31/17) as well as two comparable pre-PAUSE time periods (10/1/13-3/31/14 and 10/1/14-3/31/15).
RESULTS
One hundred sixty three study participants were identified with mean age of 11 and mean Injury Severity Score of 10.8. One hundred fifteen participants (70.6%) were transferred from outside facilities. The Pediatric PAUSE was performed for 41/163 (25%) participants. There was no significant difference in time to disposition to the Operating Room, inpatient unit, or home for participants who had the Pediatric PAUSE versus those who did not. Participants with Pediatric PAUSE had a significantly longer time to PICU admission.
CONCLUSIONS
Implementation of a Pediatric PAUSE did not alter time to disposition except the PICU. Length of time to PICU admission was longer for patients with PAUSE performed, for unclear reasons. Prospective study using a patient-centered questionnaire will be needed to objectively analyze psycho-social stress and recall of the trauma evaluation.


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