Using VPS
Outside the Walls of the PICU
Kosair Children’s Hospital
• 267 bed hospital which serves as the primary
pediatric teaching facility for the University of
Louisville School of Medicine
• Level 1 Trauma designation
• 26 bed PICU
• Magnet hospital
• PICU is a Silver Beacon unit
• VPS participant since 2001
• 2200 admissions per year
Original Objectives
• 2001
• Educate health care providers
• Educate the general public
• Educate the judicial and legislative branches of
the government
TEN-4 BRUISING RULE
ANY bruising of the
• TORSO
• EARS
or
• NECK
in a child 4 years of age or younger
OR
ANY bruising, ANYWHERE, on a
child 4 months of age or younger
Pierce et al. Bruising Characteristics Discriminating Physical Child Abuse
From Accidental Trauma. Pediatrics. December 2009.
House Bill 250
• Education of all nurses, day care providers,
CPS workers, EMS personnel and others about
Pediatric Abusive head trauma.
• Norton Healthcare birthing centers were to
start mandatory education concerning “crying
babies” and “shaking babies”
• It was passed (barely) and signed into law.
Commitment Statement
Reserve:
2014
JAN
FEB
MAR
APR MAY JUN JUL AUG
SEP
OCT
NOV
DEC
# TRAUMA PATIENTS
15
3
15
23
13
22
17
# INFECTIONS
1
1
0
5
0
0
Delay in diagnosis
1
0
0
0
1
# VENTILATED PATIENTS
4
1
2
5
5
# VENT DAYS
12.7
1.25
10.7
51
17
16
24
13
6
184
0
0
0
0
0
1
8
0
0
0
1
0
0
0
3
3
2
2
2
2
3
1
32
2.4
2.2
14
20.2
174
# EXTUBATIONS W/IN 24 HRS
2
0
1
1
4
0
0
0
1
1
3
0.00
13
# REINTUBATIONS W/IN 24 HRS
0
0
2
0
0
1
0
0
0
0
0
0
3
# UNPLANNED EXTBATIONS
0
0
0
0
0
0
0
0
0
0
0
0
0
# DVT
0
0
0
1
0
1
0
0
0
0
0
0
2
MLS IN DAYS
54
6.7
36
96
35
78
35
52
36
44
39.3
37
549
AVERAGE PIM 2 MORTALITY SCORE
-4.3
-4
-4.4
-4.2
-4
-4
-4
-4
-4.5
-4.5
-4.2
-4.3
-4.28
ACTUAL MORTALITY RATE
0%
0%
0%
4% 0% 0% 6% 0%
0%
0%
0%
0%
1%
# NAT
3
0
2
5
2
0
2
5
2
3
2
0
26
# NAT DEATHS
0
0
0
0
0
0
1
0
0
0
0
0
1
Transport run sheet in EMR
11
2
2
12
6
9
9
6
6
12
8
1
84
Total # of Transports
14
3
13
21
11
20
16
17
14
23
15
6
173
9.5 27 4.5 18
2014 Totals
Partnership to Eliminate Child Abuse
Partners throughout Kentucky and Indiana
Consistent messaging
Dissemination of Information
Education and Awareness
Child Fatality and
Near Fatality External Review Panel
• 2013 is the first annual report
• The General Assembly enacted KRS 620.055
which created this panel and it was signed into
law by Governor Steven Beshear in our lobby
IMPACT
•
•
•
•
•
•
Informed
Mothers
Prevent
Abused
Children
Today…Tomorrow…Together
PICU Non-Accidental Trauma
2002-2014
TEN-4 Bruising Rule
• Patients are being seen earlier due recognition
of bruising as a early sign of physical abuse
• Interventions and care contracts are making a
difference.
• Prospective study that is funded by National
Institute of Health
Health Care Provider
• House Bill 157 passed into law for all healthcare
providers who see children are required to take
CME for Pediatric Abusive Head Trauma
• Science of bruising
• Monthly abusive head trauma conference
• Residents rotate with Pediatric Forensics
• TEN 4 pocket card was developed by residents
2015
Public Education
• Hope for Tomorrow video to all Birthing Centers
in Kentucky
• Price is right
• Spanish version is coming
• Commitment statement after viewing
Research Plans
• Kentucky Children’s Hospital to begin using VPS
• Multi center trauma study
• Look at areas that have initiated “Hope for
Tomorrow”
• Look at injuries caused by unrelated caregivers
2015 Kentucky is #1 in Basketball
Child Abuse Deaths
• In 2005 Kentucky was ranked #1 among the 50
states for child abuse deaths
• 2013 data from the Child Maltreatment
Report done by the United States Department
of Health and Human Services Kentucky now
ranks #22