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Incorporating a Trauma-Informed Care Protocol Into Pediatric Trauma Evaluation: The Pediatric PAUSE Does Not Delay
Brendin R Beaulieu-Jones1, Sarah Bingham2, Kurt K Rhynhart3
1From the Geisel School of Medicine at Dartmouth, Hanover.
Insights
The Pediatric PAUSE protocol, addressing psychosocial needs in pediatric trauma patients, did not delay emergent imaging. This intervention supports children
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Child Psychology
Background:
- Pediatric trauma evaluations in the emergency department (ED) can be stressful for children.
- The Pediatric PAUSE protocol was developed to minimize pain, anxiety, and unnecessary interventions in stable pediatric trauma patients.
- The protocol addresses Pain/Privacy, Anxiety/IV Access, Urinary Catheter/Rectal/Genital exams, Support, and Patient Education/PICU engagement.
Purpose of the Study:
- To assess if implementing the Pediatric PAUSE protocol impacts the timeliness of emergent imaging in pediatric trauma patients.
- To evaluate the effect of the Pediatric PAUSE on patient disposition.
Main Methods:
- A retrospective study comparing pediatric trauma activations before and after the Pediatric PAUSE implementation (October 1, 2016-March 31, 2017).
- Analysis of patient demographics, time to first imaging study, and time to ED disposition.
- 172 patients (0-18 years) were included, with the PAUSE performed in 25% of cases.
Main Results:
- No significant difference was found in the time to the first imaging study between patients who underwent the Pediatric PAUSE and those who did not (18.4 vs. 15.0 minutes, P = 0.09).
- The mean age was 10.9 years, with a mean injury severity score of 10.6.
- 68.5% of patients were transferred from other hospitals, and 87.8% had prior imaging.
Conclusions:
- The Pediatric PAUSE is an effective practice intervention for addressing the psychosocial needs of pediatric trauma patients and their families.
- Implementation of the Pediatric PAUSE does not delay critical imaging services in pediatric trauma care.
- The protocol aims to prevent posttraumatic stress symptoms in pediatric patients.
Objectives:
Trauma evaluation in the emergency department (ED) can be a stressful event for children. With the goal of minimizing pain, anxiety, and unneeded interventions in stable patients, we implemented the Pediatric PAUSE at our level 1 adult/level 2 pediatric trauma center. The Pediatric PAUSE is a brief protocol performed after the primary survey, which addresses Pain/Privacy, Anxiety/IV Access, Urinary Catheter/Rectal exam/Genital exam, Support from family or staff, and Explain to patient/Engage with PICU team. The aim was to assess whether performing the PAUSE interfered with timeliness of emergent imaging in pediatric patients and their disposition.
Methods:
We identified all patients aged 0 to 18 years evaluated as trauma activations at our institution after the Pediatric PAUSE was implemented (October 1, 2016-March 31, 2017) as well as 2 analogous 6-month pre-PAUSE periods. Patient demographics, time to imaging studies, and time to ED disposition were analyzed.
Results:
One hundred seventy-two patients met the study criteria, with a mean age of 10.9 years and mean injury severity score of 10.6. One hundred fifteen participants (68.5%) were transferred from other hospitals, and 101 (87.8%) had ≥1 imaging study performed before arrival. The Pediatric PAUSE was performed for 41 (25%) of 163 study participants. There was no difference in time to first imaging study in participants for whom the PAUSE was performed (18.4 vs 15.0 minutes, P = 0.09).
Conclusions:
The PAUSE is a practice intervention designed to address the psychosocial needs of pediatric trauma patients and their families to help prevent posttraumatic stress symptoms. Implementation did not interfere with the timeliness of first imaging in pediatric trauma patients.
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