Compliance With Non-Accidental Trauma Bundle With Resulting Outcomes
Ameer Al-Hadidi, Kevin Dolan, Dana L Noffsinger, Berkeley L Bennett, *Rajan K Thakkar, Megan M Letson, Kristin G Crichton
Nationwide Children's Hospital, Columbus, OH
BackgroundNon-accidental trauma (NAT) when not appropriately identified, may be life-threatening. After identification of several missed opportunities for earlier intervention, a multidisciplinary team was assembled to improve identification and standardize evaluation at our institution. Interventions included the development of age-based clinical guidelines and an evidence-based NAT bundle. We aimed to evaluate compliance with bundle activation and outcomes. MethodologyThe NAT bundle was initiated at Nationwide Children’s Hospital (NCH) with a focus on patients <7 months, as they represented the highest mortality risk and largest group with a missed opportunity to intervene. The bundle included a skeletal survey, head CT, liver transaminases, and social work consultation. Compliance was defined as completion of all elements for patients with presentations concerning for NAT. Monitoring of bundle compliance was initiated in August 2019. Additionally, we assessed patients of all ages with re-injury encounters for missed opportunities to intervene. Results From January 2019-March 2021, 1,133 patients <7 months presented to NCH emergency departments. 823 (72.6%) triggered the NAT bundle. After initiating compliance monitoring, average bundle compliance was 93.2% over the first 8 months and improved to 100% during the last 12 months. NAT re-injury encounters occurred in 19 (1.7%) of patients <7 months and in 305 (1.2%) patients of all ages. ConclusionImplementing guidelines and an EMR-based NAT bundle has allowed for consistent evaluation of NAT in pediatric patients with high bundle compliance. Re-injury encounters are extremely low, and the number has remained constant, despite significantly increasing the number of patients surveyed, suggesting screening for NAT is being conducted accurately.
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