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The Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in severe traumatic brain injury: a single-centre

Monica S Vavilala1, Mary A King2, Jen-Ting Yang3

  • 1Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA.

The Lancet. Child & Adolescent Health
|November 27, 2018
PubMed

Insights

The Pediatric Guideline Adherence and Outcomes (PEGASUS) program improved survival and discharge outcomes for children with severe traumatic brain injury. Adherence to key performance indicators like nutrition and cerebral perfusion pressure was linked to better results.

Area of Science:

  • Pediatric critical care medicine
  • Neuroscience
  • Trauma surgery

Background:

  • No established in-hospital care programs for pediatric traumatic brain injury (TBI) exist.
  • The Pediatric Guideline Adherence and Outcomes (PEGASUS) program was developed to address this gap.
  • This study evaluated the implementation and effectiveness of the PEGASUS program in children with severe TBI.

Purpose of the Study:

  • To assess the implementation of the PEGASUS program in a hospital setting.
  • To evaluate the effectiveness of the PEGASUS program in improving outcomes for pediatric TBI patients.
  • To determine the association between adherence to key performance indicators and patient discharge outcomes.

Main Methods:

  • A prospective hybrid implementation and effectiveness study was conducted at Harborview Medical Center.
  • Included were children (<18 years) with traumatic brain injury.
  • Assessed were service provision, adherence to three key performance indicators (nutrition, hypocarbia, cerebral perfusion pressure), and discharge outcomes using Poisson regression.

Main Results:

  • 199 children participated; 193 had severe TBI.
  • Adherence to at least one key performance indicator was 96%; adherence to all three was 42%.
  • Adherence to nutrition and cerebral perfusion pressure indicators was associated with higher survival and favorable discharge disposition in a dose-response manner.

Conclusions:

  • The PEGASUS program, a multilevel, hospital-wide intervention, shows promise for pediatric severe TBI patients.
  • Key performance indicators for cerebral perfusion pressure, nutrition, and hypocarbia are crucial components of the PEGASUS program.
  • Adherence to these indicators is significantly associated with improved discharge outcomes, including survival and disposition.
Abstract

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