- Emergency departments (EDs) hitting a trifecta of PEGASUS (Pediatric Guideline Adherence and Outcomes) program targets for pediatric severe traumatic brain injury (TBI) may see more favorable discharge outcomes.
- 3 targets relate to cerebral perfusion pressure, nutrition, and hypocarbia.
Why this matters
- Authors: PEGASUS might also benefit children who come in with mild-moderate TBI that deteriorates.
- Editorial: implementation of PEGASUS represents an opening to improving results and ensuring effective care implementation in other acute care settings.
- Adherence to all 3 performance indicators in 42%.
- Adherence and discharge survival improvement by indicator (all unadjusted relative risks; 95% CIs):
- Hypocarbia: 72%;
- Nutrition: 81% (2.70; 1.54-4.73);
- Cerebral perfusion: 64% (1.33; 1.12-1.59).
- Adherence to nutrition, cerebral perfusion indicators was tied to better discharge survival and disposition.
- Prospective hybrid implementation study, admissions to US medical center, May 1, 2011 to July 1, 2017.
- n=199, all aged
- Indicators: early nutrition initiation; avoidance of hypocarbia (PaCO2 40 mmHg) for 72 hours.
- Funding: NIH.
- No randomization.
- Only 3 indicators.
- No long-term outcomes.