Protocolized approach to the management of congenital diaphragmatic hernia: benefits of reducing variability in care

Elisabeth T. Tracy, Sarah E. Mears, P. Brian Smith, Melissa E. Danko, Diana L. Diesen, Kimberley A. Fisher, Jeff C. Hoehner, Ronald N. Goldberg, C. Michael Cotten, Henry E. Rice

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1343-1348
Number of pages6
JournalJournal of Pediatric Surgery
Volume45
Issue number6
DOIs
Publication statusPublished - 2010

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Keywords

  • Congenital diaphragmatic hernia
  • Evidence-based care guidelines
  • Protocolized care
  • Variability

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

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