Protocol-Based Standardized Endocrinological Evaluation of Children With Traumatic Brain Injury: A Quality Improvement Initiative

• Published in: Clinical pediatrics Vol. 63; no. 11; pp. 1551 - 1558
• Main Authors: Bhat, Jayalakshmi Narayan, Amato, Abbie, Schultz, Scott, Gomez, Ricardo
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-11-2024; Westminster Publications, Inc
• Subjects: Adolescent; Brain Injuries, Traumatic - complications; Child; Child, Preschool; Children; Clinical Protocols - standards; Diabetes insipidus; Endocrinology; Female; Humans; Infant; Male; Pediatrics; Pituitary; Quality control; Quality Improvement; Referral and Consultation - statistics & numerical data; Retrospective Studies; Traumatic brain injury; children; traumatic brain injury (TBI); hypothalamo-pituitary axis
• ISSN: 0009-9228; 1938-2707; 1938-2707
• DOI: 10.1177/00099228241230390

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.