@article{ref1,
title="Protocol-based standardized endocrinological evaluation of children with traumatic brain injury: a quality improvement initiative",
journal="Clinical pediatrics",
year="2024",
author="Bhat, Jayalakshmi Narayan and Amato, Abbie and Schultz, Scott and Gomez, Ricardo",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="INTRODUCTION: Traumatic brain injury (TBI) can disrupt the hypothalamo-pituitary axis, causing neuroendocrine dysfunction. As a third of children can develop post-traumatic hypothalamo-pituitary axis dysfunction (HPAD), a longitudinal follow-up is required in children with TBI. <br><br>METHOD: The study comprised a pre-quality improvement (QI) phase (baseline phase) and a QI phase (post-intervention phase). Retrospective data were collected on children with TBI at our hospital during the pre-QI phase of the study to estimate the baseline data on HPAD prevalence and pediatric endocrine referral rate. Guidance protocol for standardizing the pediatric endocrine referral, evaluation, and follow-up of children with TBI was implemented. Prospective data were collected to estimate outcome measures (prevalence of HPAD, rate of initial endocrine consultation and outpatient follow-up) and process measures (protocol adherence rate). <br><br>RESULT: Twenty-seven children, aged ≤19 years, were admitted with TBI in the pre-QI phase. The median age was 9 years. Motor vehicle accidents predominated. Thirty percent had limited endocrine evaluation, and 4% had transient cranial diabetes insipidus (DI). The QI phase included 8 children. Demographic data were similar to those in the pre-QI phase. Both outcome and process measures increased to 75% from the pre-QI phase following the protocol implementation. <br><br>CONCLUSION: A lower prevalence rate of HPAD in the current cohort may be owing to underevaluation and a smaller sample size. The QI initiative incorporating a guidance protocol-based endocrinological approach to children with TBI improved the pediatric endocrinology referral and follow-up rates.<p /> <p>Language: en</p>",
language="en",
issn="0009-9228",
doi="10.1177/00099228241230390",
url="http://dx.doi.org/10.1177/00099228241230390"
}