Protocol-Based Standardized Endocrinological Evaluation of Children With Traumatic Brain Injury: A Quality
Jayalakshmi Narayan Bhat1,2, Abbie Amato3, Scott Schultz3
1Department of Pediatric Endocrinology, Louisiana State University Health Science Center, Shreveport, LA, USA.
Insights
Traumatic brain injury (TBI) can cause neuroendocrine dysfunction. A quality improvement initiative improved pediatric endocrine referral and follow-up rates in children with TBI.
Area of Science:
- Pediatric Endocrinology
- Neuroendocrinology
- Traumatic Brain Injury
Background:
- Traumatic brain injury (TBI) can disrupt the hypothalamo-pituitary axis, leading to neuroendocrine dysfunction.
- Post-traumatic hypothalamo-pituitary axis dysfunction (HPAD) affects a significant portion of children following TBI, necessitating longitudinal follow-up.
- Standardized protocols are crucial for managing endocrine sequelae in pediatric TBI cases.
Purpose of the Study:
- To evaluate the impact of a quality improvement (QI) initiative on the management of hypothalamo-pituitary axis dysfunction (HPAD) in children with TBI.
- To assess the prevalence of HPAD and the rates of pediatric endocrine referral and follow-up before and after implementing a standardized guidance protocol.
Main Methods:
- A pre-QI (retrospective) and QI (prospective) phase study design was employed.
- Data on HPAD prevalence and endocrine referral rates were collected during the pre-QI phase.
- A guidance protocol for pediatric endocrine referral, evaluation, and follow-up was implemented, followed by prospective data collection on outcomes and process measures.
Main Results:
- In the pre-QI phase, 30% of children with TBI had limited endocrine evaluation and 4% had transient cranial diabetes insipidus.
- Following QI protocol implementation, both outcome measures (HPAD prevalence, referral, and follow-up rates) and process measures increased to 75%.
- The QI phase included 8 children, with demographic data similar to the pre-QI phase (n=27).
Conclusions:
- The quality improvement initiative, integrating a standardized endocrinological approach, significantly improved pediatric endocrinology referral and follow-up rates in children with TBI.
- While the current cohort showed a lower HPAD prevalence, this may be attributed to under-evaluation and a smaller sample size in the QI phase.
- Longitudinal follow-up and standardized protocols are essential for managing neuroendocrine dysfunction after pediatric TBI.
Introduction:
Traumatic brain injury (TBI) can disrupt the hypothalamo-pituitary axis, causing neuroendocrine dysfunction. As a third of children can develop post-traumatic hypothalamo-pituitary axis dysfunction (HPAD), a longitudinal follow-up is required in children with TBI.
Method:
The study comprised a pre-quality improvement (QI) phase (baseline phase) and a QI phase (post-intervention phase). Retrospective data were collected on children with TBI at our hospital during the pre-QI phase of the study to estimate the baseline data on HPAD prevalence and pediatric endocrine referral rate. Guidance protocol for standardizing the pediatric endocrine referral, evaluation, and follow-up of children with TBI was implemented. Prospective data were collected to estimate outcome measures (prevalence of HPAD, rate of initial endocrine consultation and outpatient follow-up) and process measures (protocol adherence rate).
Result:
Twenty-seven children, aged ≤19 years, were admitted with TBI in the pre-QI phase. The median age was 9 years. Motor vehicle accidents predominated. Thirty percent had limited endocrine evaluation, and 4% had transient cranial diabetes insipidus (DI). The QI phase included 8 children. Demographic data were similar to those in the pre-QI phase. Both outcome and process measures increased to 75% from the pre-QI phase following the protocol implementation.
Conclusion:
A lower prevalence rate of HPAD in the current cohort may be owing to underevaluation and a smaller sample size. The QI initiative incorporating a guidance protocol-based endocrinological approach to children with TBI improved the pediatric endocrinology referral and follow-up rates.
