HIPRC study on care of pediatric traumatic brain injury published in Lancet journal

HIPRC study on care of pediatric traumatic brain injury published in Lancet journal

By: HIPRC Date: November 28th, 2018

In a first of its kind study, a new paper from researchers at Harborview Injury Prevention and Research Center assessed implementation and effectiveness of hospital care guidelines for pediatric traumatic brain injury.

The study, published in The Lancet Child & Adolescent Health this month, examined the use of the Pediatric Guideline Adherence and Outcomes (PEGASUS) program at Harborview Medical Center. Researchers found strong implementation hospital-wide as well as indications that patients who met three specific performance indicators had better outcomes.

In a second key finding, the study also looked at deterioration among patients admitted with mild or moderate traumatic brain injuries, and a better understanding of this process could help hospitals respond more quickly.

HIPRC Director Monica Vavilala, M.D.

“We now can quantify what percent of children and adolescents deteriorate and need the clinical pathways in a timely manner to support their recovery,” said lead author and HIPRC Director Monica Vavilala, M.D., on The Lancet Audio podcast. “When children deteriorate, sometimes it takes time to figure out that they deteriorated. Sometimes new orders have to be written. This program allows for bedside nurses to make key determinations that the child has deteriorated and immediately implement the clinical pathways that are embedded in the PEGASUS program.”

Researchers evaluated three essential parts of the PEGASUS protocol: whether each patient received nutrition soon after diagnosis; whether they avoided unwanted hypocarbia, or decreased carbon dioxide levels, without brain herniation; and whether they maintained a particular cerebral perfusion pressure, which indicates blood flow to the brain, for 72 hours after diagnosis.

Nearly 200 children and teens were included in the study, and 97 percent of them were diagnosed with severe traumatic brain injury. Of the 105 patients with data regarding all three key performance indicators, 96 percent adhered to at least one key performance indicator and 42 percent adhered to all three.

Researchers found that both early nutrition and the target cerebral perfusion pressure were individually associated with higher discharge survival and favorable discharge disposition. When patients met additional key performance indicators, this was also associated with a higher survival rate and more favorable disposition.

Vavilala said the study highlights the important role bedside nurses play in the PEGASUS program. She also noted that further research is needed to study the program in other contexts, particularly in low resource healthcare settings.

“Most children with severe TBI receive care not in the developed world, but in low-middle income countries,” she said.

Co-authors on the study affiliated with HIPRC include associate member Mary A. King, M.D., Research Assistant Scott Erickson, BA, Research Scientist Brianna Mills, Ph.D., Research Consultant Qian Qiu, MBA, and associate members Randall Chesnut, M.D., Kenneth Jaffe, M.D. and Brian Johnston, M.D. Other co-authors include Jen-Ting Yang, M.D., Rosemary M Grant, RN, Carolyn Blayney, RN and Bryan J Weiner, Ph.D.

Learn more about HIPRC’s work with traumatic brain injury.