PEGASUS program in ED shows benefit in pediatric severe TBI

  • Vavilala MS & al.
  • Lancet Child Adolesc Health
  • 22 Nov 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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.

Limitations

  • No randomization.
  • Only 3 indicators.
  • No long-term outcomes.

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