In the summer of 2019, with the support of Harborview Injury Prevention & Research Center’s (HIPRC) INSIGHT Summer Research Program and the guidance of Dr. Megan Moore, MSW, PhD, I conducted a research project investigating possible interventions early in recovery for pediatric patients with severe traumatic brain injury (TBI).
The PEGASUS algorithm, innovated at Harborview Medical Center, has greatly improved survival rate for pediatric patients with severe TBI. While PEGASUS has improved medical outcomes, a gap remains in addressing psychosocial outcomes. The families of children who survive severe TBI often struggle to access the care their children need and are more likely to have depression and post-traumatic symptoms. Better support earlier in the course of a severe TBI may help to improve outcomes and experiences for both the pediatric patient and their family. By seeking to integrating psychosocial goals and benchmarks into the established PEGASUS pathway, it might be possible to facilitate these improvements.
In this project, twenty-three care providers were selected to represent care providers that a pediatric patient with severe TBI might encounter. Providers included physicians, nurses, social workers, and care coordinators from the emergency department, pediatric intensive care unit, pediatric inpatient floors, and pediatric rehabilitation. Providers were selected from both Harborview Medical Center and Seattle Children’s Hospital.
Each provider was interviewed regarding their experience providing care. Interviews were qualitatively and iteratively analyzed to create a model to facilitate psychosocial interventions early in the course of recovery. Providers recommended a dual approach of both institutional and individual factors that contribute to an effective framework for addressing psychosocial needs. Healthcare providers recommended interventions in three domains: (1) presenting a coordinated, clear message to caregivers; (2) reducing logistical and emotional burden of care transitions; (3) assessing and addressing individual caregiver needs and concerns. A model was created integrating these three goals across each care setting, with specific interventions that can be incorporated directly into the PEGASUS pathway.
Pediatric severe traumatic brain injury can impact the lives of the patient, their community, and their support systems. This research demonstrated that healthcare providers desire incorporating certain trauma-informed and family-centered practices at each stage of treatment to improve experiences for caregivers and outcomes for pediatric patients with severe TBI, and believe it is feasible to do so.
This work was published in the Journal of Neurotrauma in February 2021.