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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
PubMed

Insights

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.
Abstract

Keywords:
pediatricspractice guidelinequality improvement

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