NEURO CRITICAL CARE MODULE

Jose A. Pineda, MD MSCI

Thomas B. Rice, MD

Sheila Hanson, MD

Regardless of the primary diagnosis, neurological outcome has the largest impact on quality of life

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

VPS TBI Mortality

Pineda et al, 2013

- 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

Sites included in the PILOT data collection

• Children’s Hospital of Los Angeles

• Children’s Hospital of Wisconsin

• St. Louis Children’s Hospital

• PILOT study includes all cases closed in 2014-Q4

• Data Collectors collected as many cases as possible from February 12 – March 4

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

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%

• 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

Pineda et al, 2013

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

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

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)

Data Entry Forms

Trauma Information

Pre-Hospital Care

ED Care

ED Care (continued)

Non Accidental Trauma

ICU Data

ICU Data - Daily

ICU Data – Daily (Continued)

ICU Discharge

Daily PILOT

Validations

NCC Diagnosis Inclusion Criteria

NCC Diagnosis Inclusion Criteria (continued)

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

• Barry Markowitz • Mary Hartman• Casey Lauer• Brian Reisner• Christopher Cubley• Data Entry Team

Acknowledgments