ArticleThe Lancet. Child & adolescent health2019
The Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in severe traumatic brain injury: a single-centre hybrid implementation and effectiveness study.
Article in The Lancet. Child & adolescent health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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21 citing papers in PubMed, 1 synthesis or guideline pooled it, 36 citations in OpenAlex.
- Interobserver reliability and diagnostic accuracy of prehospital triage for identifying traumatic brain injury in paediatric patients: a systematic review.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2024Pooled it
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- Pediatric severe TBI in South America: Healthcare resource utilization before and during the COVID-19 pandemic.PLOS global public health · 2025Article
- Severe Traumatic Brain Injury in French-Speaking Pediatric Intensive Care Units: Study of Practices.Journal of pediatric intensive care · 2024Article
- An open window: the crucial role of the gut-brain axis in neurodevelopmental outcomes post-neurocritical illness.Frontiers in pediatrics · 2024Article
- Knowledge and Practice Gaps in Pediatric Neurocritical Care Nursing: Lessons Learned From a Specialized Educational Boot Camp.Critical care explorations · 2023Article
- A multicenter observational study on outcomes of moderate and severe pediatric traumatic brain injuries-time to reappraise thresholds for treatment.Acta neurochirurgica · 2023Observational
- Relationship between guideline adherence and outcomes in severe traumatic brain injury.Annals of the Royal College of Surgeons of England · 2023Review
- Performance of plasma von Willebrand factor in acute traumatic brain injury: relations to severity, CT findings, and outcomes.Frontiers in neuroscience · 2023Article
- Article
- Exploring Trends in Neuromonitoring Use in a General Pediatric ICU: The Need for Standardized Guidance.Children (Basel, Switzerland) · 2022Article
- The brain in pediatric critical care: unique aspects of assessment, monitoring, investigations, and follow-up.Intensive care medicine · 2022Review
- Experience with clinical cerebral autoregulation testing in children hospitalized with traumatic brain injury: Translating research to bedside.Frontiers in pediatrics · 2022Article
- The Status of Quality Improvement Programs for Pediatric Traumatic Brain Injury Care in Argentina.The Journal of surgical research · 2021Article
- Provider Perspectives on Early Psychosocial Interventions after Pediatric Severe Traumatic Brain Injury: An Implementation Framework.Journal of neurotrauma · 2021Article
- Survey of resources available to implement severe pediatric traumatic brain injury management guidelines in low and middle-income countries.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2020Article
- Dissemination, implementation, and de-implementation: the trauma perspective.Trauma surgery & acute care open · 2020Article
- Agreement Between Arterial Carbon Dioxide Levels With End-Tidal Carbon Dioxide Levels and Associated Factors in Children Hospitalized With Traumatic Brain Injury.JAMA network open · 2019Observational
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12 authors at 4 institutions in 1 country.
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Abstract
backgroundAs far as we know, there are no tested in-hospital care programmes for paediatric traumatic brain injury. We aimed to assess implementation and effectiveness of the Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in children with severe traumatic brain injury.
methodsWe did a prospective hybrid implementation and effectiveness study at the Harborview Medical Center (Seattle, WA, USA). We included children (aged <18 years) with traumatic brain injury (trauma mechanism and image findings). We assessed service provision, adherence to three key performance indicators, and discharge outcomes associated with the PEGASUS programme. The three key performance indicators were early initiation of enteral (oral or tube feeds) or parenteral nutrition; avoidance of any unwanted hypocarbia (PaCO
findingsBetween May 1, 2011, and July 1, 2017, 199 children (median age 11·9 years [IQR 3·4-16·1]) participated in the PEGASUS programme, of whom 193 (97%) had severe traumatic brain injury and six (3%) had moderate traumatic brain injury. 105 patients contributed data for all three key performance indicators. Adherence to at least one key performance indicator was achieved by 101 (96%) of 105 participants, and 44 (42%) achieved adherence to all three key performance indicators. Programme participants achieved adherence to the key performance indicators of hypocarbia (76 of 105 [72%]), nutrition (162 of 199 [81%]), and cerebral perfusion pressure (128 of 199 [64%]). Adherence to the nutrition key performance indicator was associated with higher discharge survival (relative risk [RR] 2·70, 95% CI 1·54-4·73) and a more favourable discharge disposition (3·05, 1·52-6·11). Adherence to the cerebral perfusion pressure key performance indicator was also associated with higher discharge survival (RR 1·33, 95% CI 1·12-1·59) and favourable disposition (1·53, 1·19-1·96). Adherence to each additional key performance indicator was associated with higher survival (RR 1·27, 1·12-1·44) and a more favourable discharge disposition (1·46, 1·23-1·72), in a dose-response manner.
interpretationThe multilevel, hospital-wide, high-fidelity PEGASUS programme might benefit children and adolescents admitted to the emergency department with severe traumatic brain injury. Cerebral perfusion pressure, nutrition, and hypocarbia targets are essential components of the PEGASUS programme and are associated with favourable discharge outcomes.
fundingNational Institutes of Health.
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