Jose A. Pineda, MD MSCI Thomas B. Rice, MD Sheila Hanson, MD.
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Transcript of Jose A. Pineda, MD MSCI Thomas B. Rice, MD Sheila Hanson, MD.
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NEURO CRITICAL CARE MODULE
Jose A. Pineda, MD MSCI
Thomas B. Rice, MD
Sheila Hanson, MD
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Regardless of the primary diagnosis, neurological outcome has the largest impact on quality of life
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Neurological Diagnosis and Pediatric Intensive Care
• 3X use of Intensive Care and account for 50% of deaths• In the ICU: 3X mortality, significantly longer LOS, higher
median cost
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VPS TBI Mortality
Pineda et al, 2013
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- 91 children urgently admitted to the ICU for resuscitation- 1 mo abnormal adaptive behavior functioning- Also abnormal functional outcome and poor quality of life
Ebrahim et al, 2013
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Sites included in the PILOT data collection
• Children’s Hospital of Los Angeles
• Children’s Hospital of Wisconsin
• St. Louis Children’s Hospital
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• PILOT study includes all cases closed in 2014-Q4
• Data Collectors collected as many cases as possible from February 12 – March 4
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SitesTotal
DischargesTotal Eligible
CasesCases Collected
in PILOTChildren's Hospital Los Angeles 399 125 15St Louis Children's Hospital 460 162 11Children's Hospital of Wisconsin 354 146 78
1213 433 104
Total Discharges: Number of cases discharged in 2014-Q4 Total Eligible Cases: Number of cases that met NCC inclusion criteriaCases Collected in PILOT: Number of cases with NCC collected during PILOT period
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Demographic DataGender Cases Total Cases % of Total
Male 62 104 59.62%Female 42 104 40.38%
Outcome Cases Total Cases % of TotalSurvived 96 104 92.31%Died 8 104 7.69%
Race Cases Total Cases % of TotalCaucasian/European Non-Hispanic 47 104 45.19%African American 25 104 24.04%Hispanic 19 104 18.27%Asian/Indian/Pacific Islander 5 104 4.81%Other/Mixed 4 104 3.85%Unspecified 3 104 2.88%American Indian/Indigenous 1 104 0.96%
Patient Type Cases Total Cases % of TotalScheduled 22 104 21.15%Unscheduled 82 104 78.85%
Post-Operative Cases Total Cases % of TotalNo 67 104 64.42%Yes 37 104 35.58%
Age Category Cases Total Cases % of Total< 1 Month 3 104 2.88%1 Month - 23 Months 22 104 21.15%2 Years - 5 Years 31 104 29.81%6 Years - 12 Years 27 104 25.96%13 Years - 18 Years 18 104 17.31%> 18 Years 3 104 2.88%
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• 25% (n=26) of the cases in the PILOT had a head trauma
• 80.1% (n=21) of the head trauma cases had an ISS score
Min: 8 Median: 26 Average: 23.86 Max: 50
Type of Injury Cases Total Cases % of TotalPedestrian (hit by vehicle) 4 26 15.38%Motor vehicle accident (car) 4 26 15.38%Gunshot wound 4 26 15.38%Fall from height >1 meter (3ft) 4 26 15.38%Suspected abusive head trauma 3 26 11.54%Bicycle accident 3 26 11.54%Ground level fall 1 26 3.85%Direct impact (blow to head, head against object) 1 26 3.85%Other 2 26 7.69%
Type of Injury for cases with a documented Head Trauma (n=26)
Trauma Information
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Pineda et al, 2013
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Trauma Information (cont.)
• 11.5% (n=3) of the head trauma cases had CPR during pre-hospital care
• 19.2% (n=5) of the head trauma cases had a clinical seizure documented during pre-hospital care
• 42.3% (n=11) of the head trauma cases needed supplemental oxygen provided by EMS during pre-hospital care
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ICU Discharge Data (n=104)
PCPC PCPC Description Cases Total Cases % of Total -- Unknown 1 104 0.96%1 Normal 35 104 33.65%2 Mild disability 23 104 22.12%3 Moderate disability 27 104 25.96%4 Severe disability 11 104 10.58%5 Coma or vegetative state 1 104 0.96%6 Brain death 6 104 5.77%
ICU Discharge Data: PCPC
POPC POPC Description Cases Total Cases % of Total -- Unknown 1 104 0.96%1 Good overall performance 13 104 12.50%2 Mild overall disability 32 104 30.77%3 Moderate overall disability 37 104 35.58%4 Severe overall disability 14 104 13.46%5 Coma or vegetative state 1 104 0.96%6 Brain death 6 104 5.77%
ICU Discharge Data: POPC
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Preliminary Data Collection Times (n=104)
Type of Patient% of Total Cases Minimum Median Average Maximum
Average # of ICU Days Collected
Head Trauma Cases 25% 20 44.5 76.4 210 4.83Non-Head Trauma Cases 75% 10 24.5 35.3 141 3.00
Total Cases 100% 10 27 44.85 210 3.42
Preliminary Times per case (minutes)
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Data Entry Forms
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Trauma Information
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Pre-Hospital Care
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ED Care
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ED Care (continued)
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Non Accidental Trauma
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ICU Data
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ICU Data - Daily
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ICU Data – Daily (Continued)
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ICU Discharge
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Daily PILOT
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Validations
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NCC Diagnosis Inclusion Criteria
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NCC Diagnosis Inclusion Criteria (continued)
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Conclusions
• Pilot data in the NCC module confirms this is a great opportunity
• Consider participating: good return on investment
• Need to initiate hypothesis driven projects as soon as possible
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• Barry Markowitz • Mary Hartman• Casey Lauer• Brian Reisner• Christopher Cubley• Data Entry Team
Acknowledgments