Management Guidelines for Mild Traumatic Head Injured Patients
Christopher J. Sorrentino, RN1, Holly Acierno, RN1, Nwanneka Okolo, MD2, Boris Khodorkovsky, MD3, Gal Altberg, MD3, Rosemarie Basile, PhD4, Mitchell R. Price, MD5
1Northwell Health, Staten Island University Hospital, Division Of Trauma; 2Northwell Health, Staten Island University Hospital, Division Of Pediatric Neurology; 3Northwell Health, Staten Island University Hospital, Department Of Emergency Medicine; 4Northwell Health, Staten Island Universtiy Hospital, Rehabilitation Medicine; 5Northwell Health, Staten Island University Hospital, Department Of Pediatric Surgery & Trauma
Background: There continues to be disparity in the literature on how to best manage the mild traumatic head injured patient. Do we obtain a head CT on everyone? We know this answer to be no, but if no head CT, what is an appropriate time of observation? This question came up time and again at our trauma center and a decision by the Pediatric Trauma Service was to evaluate the evidence and work with our pediatric colleagues across the hospital to develop a process we could all support.
Methods: In order to accomplish the goals for the mTBI Collaborative, the SIUH Pediatric Trauma team implemented a PDSA cycles that would: Identify stakeholders, Arrange stakeholder meetings, Evaluate resources, Evaluate data, Develop an algorithm, Implement and rollout algorithm, Evaluate the algorithm /pathway, Plan for further program improvements, Develop IRB research protocol to validate findings.
Results: While more data is needed to be collected and analyzed, preliminary data review reveals a 80% reduction in PICU admissions when comparing December 2016 pediatric admissions against December 2017 pediatric admissions.
Conclusions: Development of the Initial Management Guidelines for mild traumatic head injured patients, has been extremely positive for the relationship between our Emergency Medicine providers and our Pediatric Trauma providers. Through this project, we have been able to decrease the LOS of our Pediatric Head Injured Patients in the ED as well reduce the average number of PICU days and admission denials. Raw data will be available once trauma registry data is completed for 4Q 2017.
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