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Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Pediatric Palliative Care Referral Criteria Following Moderate or Severe Traumatic Brain Injuries
Ruth Villarosa1, Daniel H Grossoehme1,2, Miraides Brown2
1Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, Ohio, USA.
Insights
Palliative care (PC) referral criteria for pediatric traumatic brain injury (TBI) patients were developed. These evidence-based guidelines aim to ensure PC resources are allocated to children with the greatest need, optimizing care for TBI survivors.
Area of Science:
- Pediatric neurology
- Neurotrauma research
- Palliative care medicine
Background:
- Traumatic brain injuries (TBIs) are a major cause of death and disability in children.
- Survivors often face long-term cognitive, physical, and behavioral challenges.
- Effective resource allocation for palliative care (PC) is crucial.
Purpose of the Study:
- To characterize the pediatric population with moderate-to-severe TBI.
- To formulate evidence-based referral criteria for specialist palliative care (PC) consults.
- To guide the optimal allocation of finite PC resources.
Main Methods:
- Retrospective chart review of patients with moderate or severe TBI.
- Data collected from January 1, 2017, to October 1, 2021.
- Exclusion of patients admitted from outside hospitals or with non-qualifying diagnoses.
Main Results:
- 33 patients with moderate or severe TBI were identified; 17 received PC consults.
- No significant demographic differences were found between groups.
- Clinical and outcome variables informed the proposed PC referral criteria.
Conclusions:
- Specialist pediatric PC is a finite resource that should target patients with the greatest need.
- Proposed criteria offer empirical guidance for consulting pediatric PC for TBI.
- Further research is needed to validate these criteria and their impact on outcomes.
Abstract:
Traumatic brain injuries (TBIs) are one of the leading causes of death and disability in children and adolescents. A significant number of those who survive suffer from the lasting cognitive, physical, or behavioral effects of TBI while the loss is devastating for families. The aim of the study is to characterize the pediatric population and formulate referral criteria for palliative care (PC) consults who would guide the most beneficial allocation of resources. This is an IRB-approved retrospective chart review study from January 1, 2017, to October 1, 2021, of persons presenting to the emergency department of a 467-bed quaternary pediatric hospital in the midwest with a moderate or severe TBI (ICD-10: S.06.2X and S.06.5X9A). Participants were excluded if they were admitted directly from an outside hospital or if the diagnosis code did not meet criteria. N = 33 patients presented with moderate or severe TBI, of which 17 had PC consult. There were no significant between-group demographic differences. Significant differences in clinical and outcome variables formed the basis of proposed referral criteria for specialist PC for children and adolescents sustaining a moderate-to-severe traumatic brain injury. PC programs are a finite resource and should be available to and focused on those with greatest need. The proposed criteria provide empirically based guidance on when to consult, or consider consulting, specialist pediatric PC. Further testing of these criteria and their relationship with improved outcomes are desirable.
