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Optimizing Resource Utilization: Palliative Care Consultations in Pediatric Trauma Patients
Julie Goswami, Jacob W. Baxter, Brenda A. Schiltz, *Terri A. Elsbernd, Grace M. Arteaga, *Denise B. Klinkner
Mayo Clinic, Rochester, MN

Background: The American College of Surgeons Trauma Quality Improvement Program (TQIP) and Committee on Trauma released a best practice guideline for palliative care in trauma patients in 2017. The pediatric palliative care team (ComPASS) was established at our institution in 2014 but its utilization within the trauma population is unknown. We sought to identify patients who received the consultation and develop criteria of patients who would benefit from these resources.Methods: The institutional pediatric trauma registry was queried to identify all admissions <18 years old to the Pediatric Intensive Care Unit (PICU) or Trauma ICU (TICU) from 2014-2021 and demographics obtained. Charts were reviewed to identify consultations to the ComPASS team and outcomes. A practice management guideline (PMG) for palliative care consultations was developed based on the TQIP guideline and applied retrospectively.Results: 399 patients were admitted to the PICU/TICU, with 299 of these being PICU admissions under the age of 15. There were 30 (7.5%) deaths, 20 (66.7%) within 24 hours of admission. Palliative care consultations were obtained in 25 (6.3%). Of these, 10 (40%) patients were infants/toddlers <age 2, all had traumatic brain injury, 3 (12%) were for suspected child abuse, and many were for “goals of care” or family meetings. When the PMG was applied retrospectively, 109 (27.3%) patients met criteria for consultation.Conclusion: Our results demonstrate an underutilization of the palliative care team. Further studies will determine the utility of a PMG implementation for early involvement of ComPASS in critically ill pediatric trauma patients.
Table: Palliative Care Utilization in Critically Ill Pediatric Trauma Patients

YearAll ICU AdmissionsPalliative Care ConsultsRetrospectively met PMG criteria
2014 – 20172111244
2018 – 202118813*65

*Three cancelled due to death prior to team assessment
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