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Optimizing resource utilization: palliative care consultations in critically ill pediatric trauma patients
Julie Goswami1,2, Jacob Baxter3, Brenda M Schiltz4
1Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Trauma Surgery & Acute Care Open
|November 29, 2023
Summary
Pediatric palliative care consultations are underutilized in trauma patients. Developing criteria can help identify more patients who would benefit from these essential services.
Area of Science:
- Trauma Care
- Palliative Medicine
- Pediatric Critical Care
Background:
- The American College of Surgeons Trauma Quality Improvement Program (TQIP) released guidelines for palliative care in trauma patients in 2017.
- Utilization of pediatric palliative care for pediatric trauma patients remains understudied.
- This study addresses the gap in understanding palliative care consultation for critically ill pediatric trauma patients.
Purpose of the Study:
- To identify pediatric trauma patients who received palliative care consultations.
- To develop criteria for identifying pediatric trauma patients who would benefit from palliative care services.
- To assess the impact of a clinical practice guideline (CPG) on palliative care consultation rates.
Main Methods:
- A retrospective review of the institutional pediatric trauma registry (2014-2021) identified patients aged 0-17 admitted to the ICU/TICU.
- Electronic medical records were analyzed for palliative care consultations.
- A CPG based on TQIP guidelines was developed and applied retrospectively, then prospectively.
Main Results:
- Of 399 patients, 30 (7.5%) died, with 20 (66.7%) within 24 hours of admission.
- Palliative care consultations were obtained in only 5.3% of patients.
- Retrospective application of the CPG identified 27.3% of patients as meeting criteria for consultation. Prospective implementation resulted in a 25% consultation rate.
Conclusions:
- Palliative care services are underutilized in critically ill pediatric trauma patients.
- A CPG can significantly increase the identification and consultation of pediatric trauma patients for palliative care.
- Further studies are needed to analyze the utility of CPG implementation for early palliative care involvement.
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