Impact of a Dedicated Trauma Activation Alert for Severe Traumatic Brain Injury in Pediatric Patients
*Andrew Nordin, *Brian D Kenney, *Eric Sribnick, *Rajan K Thakkar
Nationwide Children's Hospital, Columbus, OH
Traumatic Brain Injury (TBI) in children results in significant morbidity and mortality. For patients with injuries that require surgery, early intervention may mitigate the severity of neurodevelopmental sequelae. We developed a specific activation for severe TBI, and hypothesized that its use would improve outcomes.
We created a Level 1 Neuro trauma alert activation (L1N) for pediatric patients with suspected severe TBI, which went into effect in 8/2014. We performed a retrospective chart review for 17 consecutive months before (Group 1) and after (Group 2) L1N implementation. Data were collected including demographics, neurosurgery response time, time to OR, ICU and hospital length of stay (LOS), mortality, and neurologic outcomes. Statistics were analyzed using Student’s t-test or chi-square analysis.
Group 1 contained 45 patients, 23 of whom would have met activation criteria (51.1%), and Group 2 contained 31 L1N activations, 14 of which met activation criteria (45.1%; p = 0.61). There were no demographic differences between groups. Group 2 had a significantly decreased neurosurgery response time (29.2 v 5.9 minutes; p <0.00001) and time to OR (1.16 v 0.64 hours; p = 0.02). There was no difference in neurologic outcomes as measured by the Glasgow Outcome Scale (GOS; p = 0.33). For patients meeting activation criteria, GOS was not different between groups (p = 0.37), but subjective neurologic outcomes improved significantly (p = 0.02).
Conclusions (implications for practice):
Our dedicated neurotrauma activation decreased time to neurosurgical evaluation and intervention, with a trend towards improved neurologic outcomes. Continued application and data collection may demonstrate further improvements in neurologic outcomes.
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