TY - JOUR
T1 - Protocolized approach to the management of congenital diaphragmatic hernia
T2 - benefits of reducing variability in care
AU - Tracy, Elisabeth T.
AU - Mears, Sarah E.
AU - Smith, P. Brian
AU - Danko, Melissa E.
AU - Diesen, Diana L.
AU - Fisher, Kimberley A.
AU - Hoehner, Jeff C.
AU - Goldberg, Ronald N.
AU - Cotten, C. Michael
AU - Rice, Henry E.
PY - 2010/6
Y1 - 2010/6
N2 - Purpose: Variable approaches to the care of infants with congenital diaphragmatic hernia (CDH) by multiple providers may contribute to inconsistent care. Our institution developed a comprehensive evidence-based protocol to standardize the management of CDH infants. This report reviews patient outcomes before and after the implementation of the protocol. Methods: Retrospective chart review of CDH infants managed with individualized care (preprotocol group, January 1997-December 2001, n = 22) or on the protocol (Protocol group, January 2002-July 2009, n = 47). Survival and other categorical variables were compared by χ2 analysis, and continuous variables were compared using 1-sided analysis of variance analysis, with significance defined as P < .05. Results: Survival to discharge was significantly greater in the Protocol group (40/47; 85%) than the preprotocol group (12/22; 52%; P = .006), although mean gestational age, mean birth weight, and expected survival were not statistically different between the 2 groups. The use of supportive therapies, including high-frequency jet ventilation, inhaled nitric oxide, and extracorporeal life support, was similar between groups as well. Conclusions: Since the implementation of a management protocol for infants with CDH, survival has improved significantly compared with expected survival and preprotocol controls. Reduction in the variability of care through use of an evidence-based protocol may improve the survival of CDH infants.
AB - Purpose: Variable approaches to the care of infants with congenital diaphragmatic hernia (CDH) by multiple providers may contribute to inconsistent care. Our institution developed a comprehensive evidence-based protocol to standardize the management of CDH infants. This report reviews patient outcomes before and after the implementation of the protocol. Methods: Retrospective chart review of CDH infants managed with individualized care (preprotocol group, January 1997-December 2001, n = 22) or on the protocol (Protocol group, January 2002-July 2009, n = 47). Survival and other categorical variables were compared by χ2 analysis, and continuous variables were compared using 1-sided analysis of variance analysis, with significance defined as P < .05. Results: Survival to discharge was significantly greater in the Protocol group (40/47; 85%) than the preprotocol group (12/22; 52%; P = .006), although mean gestational age, mean birth weight, and expected survival were not statistically different between the 2 groups. The use of supportive therapies, including high-frequency jet ventilation, inhaled nitric oxide, and extracorporeal life support, was similar between groups as well. Conclusions: Since the implementation of a management protocol for infants with CDH, survival has improved significantly compared with expected survival and preprotocol controls. Reduction in the variability of care through use of an evidence-based protocol may improve the survival of CDH infants.
KW - Congenital diaphragmatic hernia
KW - Evidence-based care guidelines
KW - Protocolized care
KW - Variability
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U2 - 10.1016/j.jpedsurg.2010.02.104
DO - 10.1016/j.jpedsurg.2010.02.104
M3 - Article
C2 - 20620342
AN - SCOPUS:77953862306
SN - 0022-3468
VL - 45
SP - 1343
EP - 1348
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 6
ER -