NON-ACCI DE NT AL T RAUMA I N CHI L DRE N RESULTS O F A SC REENING PO LIC Y Je nnife r Wo b ig , RN, Jo na tha n Gro tts, MA Ste phe n K a minski, MD, L ia Ma nfre di, BS E liza b e th T a ylo r-L inze y, RN Santa Bar bar a Cottage Hospital
BACKGROUND • T BI le a ding c a use o f disa b ility a nd de a th in c hildre n a nd a do le sc e nts • Sig nific a nt pe rc e nta g e fro m no n-a c c ide nta l tra uma (NAT ) • Ca n g o unre c o g nize d • Mo rta lity ra te s a re hig h fo llo wing NAT • Survivo rs le ft with se ve re ne uro lo g ic mo rb idity
BACKGROUND • Whe n to sc re e n? • Sympto ms a re no n-spe c ific , ha rd to inte rpre t • F inding s o n ima g ing c a n b e mista ke n fo r a c c ide nta l tra uma • De c isio n to fo re g o c a n ha ve se rio us c o nse q ue nc e s • Ho w to sc re e n? • Ske le ta l Surve y • Re tina l E xa m • So c ia l Se rvic e s Co nsult
STUDY PURPOSE • E va lua te the imple me nta tio n o f a NAT sc re e ning po lic y fo r its impa c t o n te st utiliza tio n a nd the ide ntific a tio n o f vic tims o f a b use
METHODS • Sa nta Ba rb a ra Co tta g e Ho spita l • L e ve l I I Pe dia tric T ra uma Ce nte r • April 2010 to April 2014 • 2 ye a rs pre -po lic y (PR) a nd 2 ye a rs po st-po lic y (PP) • Pa tie nt se le c tio n • I nc lusio n c rite ria • Ag e 0-2 • Admitte d with skull fra c ture o r I CH • Da ta • T ra uma Re g istry • Sa nta Ba rb a ra Co unty Child We lfa re Se rvic e s (CWS) re c o rds
NAT SCREENING POLICY
ANALYSIS • Pa tie nts c o mpa re d pre (PR) a nd po st (PP) imple me nta tio n o f the sc re e ning po lic y. • Da ta o n a g e , e thnic ity, g e nde r, insura nc e sta tus, ho spita l L OS a nd e xa ms pe rfo rme d • Any po sitive a sse ssme nt finding = Ho spita l suspe c te d NAT • Cro ss-re fe re nc e d with CWS da ta o n CWS re fe rra l a nd sub sta ntia te d NAT
RESULTS
RESULTS Ove ra ll Re sults T able 2: Hospital and Pr otoc ol Outc ome s Be fo re Po lic y Afte r Po lic y (n = 46) (n = 38) p-va lue 2.7 (2.6) 3.9 (4.4) 0.126 Hospital L OS (days) 36 (78.3%) 32 (84.2%) 0.487 Soc ial Wor k Consult 13 (28.3%) 26 (68.4%) < 0.001 Ske le tal Sur ve y Ophthalmology E xam 7 (15.2%) 25 (65.8%) < 0.001 7 (15.2%) 22 (57.9%) < 0.001 Re c e ive d All Polic y E xams 12 (26.1%) 17 (44.7%) 0.106 CWS Re fe r r al 8 (17.4%) 13 (34.2%) 0.128 Hospital Suspe c te d NAT 5 (10.9%) 6 (15.8%) 0.365 CWS Substantiate d NAT † †Pe r c e ntag e out of hosp suspe c te d NAT NAT : Non- ac c ide ntal T r auma CWS: Child We lfar e Se r vic e s
RESULTS Co mpa riso n o f a ll pa tie nts pre -po lic y a nd unwitne sse d po st-po lic y Compar ison of All Pr e - Polic y (PR) and Unwitne sse d E ve nts Post- Polic y (PP) Be fo re Po lic y (n=46) Afte r Po lic y (n=35) p-va lue Re c e ive d All Polic y E xams 7 (15.2) 22 (62.9) < 0.001 9 (19.6) 13 (43.3) 0.026 CWS Notifie d Hospital Suspe c te d 8 (17.4) 13 (37.1) 0.045 NAT
RESULTS Co mpa riso n b y I nsura nc e Sta tus Pr ivate Insur anc e (n = Se lf- Pay/ Me dic al (n = 33) 51) p- value Re c e ive d All Polic y 8 (24.2) 21 (41.2) 0.106 E xams Hospital L OS (days) 3.2 (3.1) 3.3 (3.9) 0.874 Hospital Suspe c te d 0.023 NAT 4 (12.1) 17 (33.)
RESULTS Co mpa riso n b y Ra c e Non- Hispanic (n = 63) Hispanic (n = 21) p- value Re c e ive d All Polic y 22 (34.9) 7 (33.3) 0.894 E xams 3.5 (4.1) 2.4 (0.9) 0.045 Hospital L OS (days) Hospital Suspe c te d 0.033 NAT 12 (19.0) 9 (42.9)
DISCUSSION • I mple me nta tio n o f a sc re e ning po lic y inc re a se d utiliza tio n o f dia g no stic to o ls in pa tie nts a g e d 0-2. • Othe r o b se rva tio ns: • Ra te o f ho spita l suspe c te d NAT do ub le d • CWS sub sta ntia te d NAT inc re a se d • Did no t re a c h sta tistic a l sig nific a nc e in c o mpa ring AL L pa tie nts PR a nd PP, ho we ve r, did in c o mpa ring a ll PR to unwitne sse d PP
CONCLUSION • We b e lie ve a multi-c e nte r pro spe c tive study wo uld b e st e va lua te this impo rta nt pro b le m in the future
THANK YOU Je nnife r Wo b ig , RN BSN T ra uma Pro g ra m Ma na g e r Sa nta Ba rb a ra Co tta g e Ho spita l 805-569-7575 jwo b ig @ sb c h.o rg
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