Comparison of the usefulness of a targeted temperature management protocol before and after modification: A single-centre retrospective study

Object Recent legislation and media coverage have heightened awareness of concussion in youth sports. Previous work by the authors' group defined significant variation of care in management of children with concussion. To address this variation, a multidisciplinary concussion program was established based on a uniform management protocol, with emphasis on community outreach via traditional media sources and the Internet. This retrospective study evaluates the impact of standardization of concussion care and resource utilization before and after standardization in a large regional pediatric hospital center. Methods This retrospective study included all patients younger than 18 years of age evaluated for sports-related concussion between January 1, 2007, and December 31, 2011. Emergency department, sports medicine, and neurosurgery records were reviewed. Data collected included demographics, injury details, clinical course, Sports Concussion Assessment Tool-2 (SCAT2) scores, imaging, discharge instructions, and referral for specialty care. The cohort was analyzed comparing patients evaluated before and after standardization of care. Results Five hundred eighty-nine patients were identified, including 270 before standardization (2007–2011) and 319 after standardization (2011–2012). Statistically significant differences (p < 0.0001) were observed between the 2 groups for multiple variables: there were more girls, more first-time concussions, fewer initial presentations to the emergency department, more consistent administration of the SCAT2, and more consistent supervision of return to play and return to think after adoption of the protocol. Conclusions A combination of increased public awareness and legislation has led to a 5-fold increase in the number of youth athletes presenting for concussion evaluation at the authors' center. Establishment of a multidisciplinary clinic with a standardized protocol resulted in significantly decreased institutional resource utilization and more consistent concussion care for this growing patient population.

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Effectiveness of a targeted temperature management protocol using a cooling blanket in critically ill children with acute brain injury

JOURNAL OF PEDIATRIC CRITICAL CARE ◽

10.21304/2018.0501.00291 ◽

2018 ◽

Vol 5 (7) ◽

pp. 84

Author(s):

Sajith Kesavan ◽

Ramachandran Bala ◽

Ravikumar Krupanandan

Keyword(s):

Brain Injury ◽

Critically Ill ◽

Acute Brain Injury ◽

Targeted Temperature Management ◽

Temperature Management ◽

Critically Ill Children ◽

Management Protocol

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Targeted temperature management after intraoperative cardiac arrest: a multicenter retrospective study

Intensive Care Medicine ◽

10.1007/s00134-017-4709-0 ◽

2017 ◽

Vol 43 (4) ◽

pp. 485-495 ◽

Cited By ~ 9

Author(s):

Anne-Laure Constant ◽

Nicolas Mongardon ◽

Quentin Morelot ◽

Nicolas Pichon ◽

David Grimaldi ◽

...

Keyword(s):

Cardiac Arrest ◽

Retrospective Study ◽

Targeted Temperature Management ◽

Temperature Management

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Targeted Temperature Management Protocol in a Pediatric Intensive Care Unit: A Quality Improvement Project

Critical Care Nurse ◽

10.4037/ccn2021554 ◽

2021 ◽

Vol 41 (5) ◽

pp. 41-50

Author(s):

Erica Prendergast ◽

Kiona Y. Allen ◽

Michele Grimason Mills ◽

Thomas Moran ◽

Z. Leah Harris ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Body Surface ◽

Pediatric Intensive Care ◽

Targeted Temperature Management ◽

Neurological Injury ◽

Temperature Management ◽

Surface Cooling ◽

Management Protocol

Background In patients with acute neurological injury, abrupt temperature change exacerbates increased intracranial pressures and negatively affects perfusion pressure and cerebral blood flow. Critical care nurses must provide coordinated and effective interventions to maintain normothermia without precipitating shivering immediately after acute neurological injury in pediatric patients. Objective To improve hyperthermia management in a 40-bed pediatric intensive care unit, an interdisciplinary pediatric critical care team developed, implemented, and evaluated a targeted temperature management protocol. Methods The project was guided by the organization’s plan-do-study-act quality improvement process. Quality improvement was assessed retrospectively using electronic medical records of patients meeting eligibility criteria. Samples of pediatric patients who received temperature interventions were compared before and after protocol implementation. The protocol included environmental, pharmacological, and body surface cooling device interventions, as well as use of a bedside shivering assessment scale and stepwise interventions to prevent and control shivering. Results Before implementation of the targeted temperature management protocol, 64% of patients had documented temperatures higher than 37.5 °C, and body surface cooling devices were used in 10% of patients. After protocol implementation, more than 80% of patients had documented temperatures higher than 37.5 °C, and body surface cooling devices were used in 62% of patients. Four patients (6%) before and 5 patients (31%) after protocol implementation were treated with body surface cooling without requiring use of neuromuscular blockade. Conclusions Creation and implementation of a targeted temperature management protocol increased nurses’ documented use of body surface cooling to manage hyperthermia in pediatric intensive care unit patients with acute neurological injury.

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