Using VPSOutside the Walls of the PICU

Kosair Children’s Hospital• 267 bed hospital which serves as the primary

pediatric teaching facility for the University of Louisville School of Medicine

• Level 1 Trauma designation• 26 bed PICU• Magnet hospital• PICU is a Silver Beacon unit• VPS participant since 2001• 2200 admissions per year

Original Objectives

• 2001

• Educate health care providers

• Educate the general public

• Educate the judicial and legislative branches of the government

TEN-4 BRUISING RULEANY bruising of the • TORSO• EARS

or• NECK

in a child 4 years of age or younger

OR

ANY bruising, ANYWHERE, on a child 4 months of age or

younger

Pierce et al. Bruising Characteristics Discriminating Physical Child Abuse From Accidental Trauma. Pediatrics. December 2009.

House Bill 250• Education of all nurses, day care providers,

CPS workers, EMS personnel and others about Pediatric Abusive head trauma.

• Norton Healthcare birthing centers were to start mandatory education concerning “crying babies” and “shaking babies”

• It was passed (barely) and signed into law.

Commitment StatementReserve:

2014 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 2014 Totals

# TRAUMA PATIENTS 15 3 15 23 13 22 17 17 16 24 13 6 184

# INFECTIONS 1 1 0 5 0 0 0 0 0 0 0 1 8

Delay in diagnosis 1 0 0 0 1 0 0 0 1 0 0 0 3

# VENTILATED PATIENTS 4 1 2 5 5 3 2 2 2 2 3 1 32

# VENT DAYS 12.7 1.25 10.7 51 9.5 27 4.5 18 2.4 2.2 14 20.2 174

# EXTUBATIONS W/IN 24 HRS 2 0 1 1 4 0 0 0 1 1 3 0.00 13

# REINTUBATIONS W/IN 24 HRS 0 0 2 0 0 1 0 0 0 0 0 0 3

# UNPLANNED EXTBATIONS 0 0 0 0 0 0 0 0 0 0 0 0 0

# DVT 0 0 0 1 0 1 0 0 0 0 0 0 2

MLS IN DAYS 54 6.7 36 96 35 78 35 52 36 44 39.3 37 549

AVERAGE PIM 2 MORTALITY SCORE -4.3 -4 -4.4 -4.2 -4 -4 -4 -4 -4.5 -4.5 -4.2 -4.3 -4.28

ACTUAL MORTALITY RATE 0% 0% 0% 4% 0% 0% 6% 0% 0% 0% 0% 0% 1%

# NAT 3 0 2 5 2 0 2 5 2 3 2 0 26

# NAT DEATHS 0 0 0 0 0 0 1 0 0 0 0 0 1

Transport run sheet in EMR 11 2 2 12 6 9 9 6 6 12 8 1 84

Total # of Transports 14 3 13 21 11 20 16 17 14 23 15 6 173

Partnership to Eliminate Child Abuse

Partners throughout Kentucky and IndianaConsistent messaging

Dissemination of InformationEducation and Awareness

Child Fatality andNear Fatality External Review Panel

• 2013 is the first annual report

• The General Assembly enacted KRS 620.055 which created this panel and it was signed into law by Governor Steven Beshear in our lobby

IMPACT• Informed• Mothers• Prevent• Abused • Children• Today…Tomorrow…Together

PICU Non-Accidental Trauma2002-2014

TEN-4 Bruising Rule

• Patients are being seen earlier due recognition of bruising as a early sign of physical abuse

• Interventions and care contracts are making a difference.

• Prospective study that is funded by National Institute of Health

Health Care Provider

• House Bill 157 passed into law for all healthcare providers who see children are required to take CME for Pediatric Abusive Head Trauma

• Science of bruising• Monthly abusive head trauma conference• Residents rotate with Pediatric Forensics• TEN 4 pocket card was developed by residents

2015Public Education

• Hope for Tomorrow video to all Birthing Centers in Kentucky

• Price is right

• Spanish version is coming

• Commitment statement after viewing

Research Plans

• Kentucky Children’s Hospital to begin using VPS

• Multi center trauma study

• Look at areas that have initiated “Hope for Tomorrow”

• Look at injuries caused by unrelated caregivers

2015 Kentucky is #1 in Basketball

Child Abuse Deaths

• In 2005 Kentucky was ranked #1 among the 50 states for child abuse deaths

• 2013 data from the Child Maltreatment Report done by the United States Department of Health and Human Services Kentucky now ranks #22