Incorporating a Trauma-Informed Care Protocol into Pediatric Trauma Evaluation: The Pediatric PAUSE© Does Not Delay Imaging or Disposition

Abstract

Background: Trauma evaluation in the Emergency Department (ED) can be a stressful event for children. With the goal of minimizing pain, anxiety, and unneeded interventions in stable patients, we implemented a Pediatric PAUSE© at our Level 1 Adult/Level 2 Pediatric Trauma Center. The Pediatric PAUSE© is a brief protocol performed after the primary survey, which addresses Pain/Privacy, Anxiety/IV Access, Urinary Catheter/Rectal exam/Genital exam, Support from family or staff, and Explain to patient/Engage with PICU team. The aim was to assess whether performing the PAUSE© interfered with timeliness of emergent imaging in pediatric patients and their disposition. Methods: We identified all patients aged 0-18 years evaluated as trauma activations at our institution after the Pediatric PAUSE© was implemented (10/1/16-3/31/17) as well as two analogous 6-month pre-PAUSE© time periods. Patient demographics, time to imaging studies, and time to ED disposition were analyzed. Findings: One hundred and seventy-two patients met study criteria, with a mean age of 10.9 years and mean Injury Severity Score of 10.6. One hundred fifteen participants (68.5 %) were transferred from other hospitals, and 101 (87.8%) had ≥1 imaging study performed prior to arrival. The Pediatric PAUSE© was performed for 41/163 (25%) study participants. There was no difference in time to first imaging study in participants for whom the PAUSE© was performed (18.4 min vs 15.0 min, p=0.09). Interpretation: The PAUSE© is a practice intervention designed to address the psychosocial needs of pediatric trauma patients and their families to help prevent PTS symptoms. Implementation did not interfere with the timeliness of first imaging in pediatric trauma patients. Funding Statement: The authors state: No funding to disclose. Declaration of Interests: The authors declare: No conflicts of interests.' Ethics Approval Statement: The study protocol was approved by the Committee for the Protection of Human Subjects at our institution, granting access to our institution’s existing trauma database and the electronic health records of study patients (Dartmouth College Committee for the Protection of Human Subjections: Study #00030129).