Development Of A Clinical Pathway For Management Of Mild Traumatic Brain Injury At A Level IV Pediatric Trauma Center
Krista Stephenson, Heather Kimbro, *Marcene McVay-Gillam
University of Arkansas For Medical Sciences, Little Rock, AR
To develop an algorithm for management of mild traumatic brain injury (mTBI) at a Level IV pediatric trauma center.
Evaluation of outcomes in mTBI has identified a low incidence of neurologic decline or need for intervention. In adult tertiary trauma centers, these patients can be safety managed by trauma surgeons without neurosurgical consultation, and there is evidence that this approach is also safe in pediatric centers. The L-IV hospital is remote from the L-I campus in our system and without on-site neurosurgeons. Avoiding transfer of patients who do not require intervention improves resource utilization and prevents patient/family displacement.
Strategy and Implementation (How):
Studies focusing on mTBI management without neurosurgical consultation were reviewed by the L-IV trauma director and L-I neurosurgeons. A pathway was created for management of patients with evidence of head injury and GCS 13-15, with subsequent approval and implementation in 10/2019. Patients are reviewed by the trauma program manager and compliance is monitored by the trauma quality program.
Evaluation/Outcomes (So what)
Since implementation, 28/309 trauma registry patients have met inclusion criteria. There have been 6 admissions and 7 transfers. 4 transfers required no intervention and could have been avoided. Pathway compliance is 78%. Ongoing review led to pathway modifications to improve performance in identifying patients for local management. Short-term feedback has improved compliance.
Implications for Practice (And now):
Leveraging system resources has prevented displacement and costly transfer of patients with mTBI. This could serve as a model for hospital systems with centralized high-acuity resources to provide high-quality care via remote lower-acuity centers.
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