P3.I173: Need for Palliative Care Consultation in the Pediatric Traumatic Injury Setting

Background: Traumatic injuries are a major contributor to pediatric mortality and morbidity, requiring many families to face serious news and make challenging decisions. Traumatic injuries kill 20,000 children and young adults in the United States each year and permanently disable another 50,000 (1). Traumatic injuries disproportionately affect lower income and BIPOC populations (2). Little is known about how many pediatric patients with a traumatic injury may benefit from specialty palliative care. The objective of this study was to characterize patient-level variables that identify which pediatric patients with a traumatic injury may benefit from palliative care and determine the proportion of pediatric trauma patients at a large, regional level 1 trauma center who met those variables.

References:
1. Stylianos S. Late sequelae of major trauma in children. Pediatr Clin North Am. 1998;45(4):853-859. doi:10.1016/S0031-3955(05)70049-3
2. Hayes JR, Groner JI. Minority status and the risk of serious childhood injury and death. J Natl Med Assoc 2005; 97:363–369

Methods: Potential palliative care consult criteria were identified via literature review. Subject-matter experts internal and external to our institution (n=18) were asked to rate each criterion on its importance for designating if a patient was likely to have benefited from a palliative care consult. The survey results generated two variable sets: one that suggested a patient was “very likely to benefit” from palliative care and another that suggested a patient “may benefit.” Subsequently, a chart review was conducted of all pediatric admissions from October 2021-September 2022 at a large, regional level 1 trauma center to determine the proportion of patients with at least one variable from either set.

Results: Variables included in the “very likely to benefit” (VB) set were: 1) requirement for prolonged invasive medical technology (e.g. intubation >7 days), 2) anticipated permanent change in function (e.g. severe brain injury), 3) multi-organ failure involving >3 systems, 4) death expected or occurred during the hospitalization, 5) complex advance care planning, 6) pre-existing life-limiting condition(s), and 7) complex symptom management. Variables included in the “may benefit” (MB) set were: 1) ICU stay >7 days, 2) hospital stay >3 weeks, 3) particularly distressing mechanism of injury (e.g. out of hospital cardiac arrest), 4) complex care coordination, and 5) ethics consultation (Table 1). The chart review consisted of 459 encounters for 435 unique patients. Of these encounters, 49% met at least one consult criteria. More specifically, 29% met at least one of the MB criteria but no VB criteria, and 14% met at least one VB criteria and at least one MB criteria, and 5.8% met at least one of the VB criteria but no MB criteria (Figure 1).

Conclusion: A one-year chart review of pediatric admissions at a large, regional level 1 trauma center identified a substantial opportunity for palliative care consultation.