Protocolized approach to the management of congenital diaphragmatic hernia: benefits of reducing variability in care.
Journal Article (Journal Article)
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 chi(2) 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.
Full Text
Duke Authors
- Cotten, Charles Michael
- Goldberg, Ronald Norman
- Rice, Henry Elliot
- Smith, Phillip Brian
- Tracy, Elisabeth Tomlinson
Cited Authors
- Tracy, ET; Mears, SE; Smith, PB; Danko, ME; Diesen, DL; Fisher, KA; Hoehner, JC; Goldberg, RN; Cotten, CM; Rice, HE
Published Date
- June 2010
Published In
Volume / Issue
- 45 / 6
Start / End Page
- 1343 - 1348
PubMed ID
- 20620342
Pubmed Central ID
- PMC3318997
Electronic International Standard Serial Number (EISSN)
- 1531-5037
Digital Object Identifier (DOI)
- 10.1016/j.jpedsurg.2010.02.104
Language
- eng
Conference Location
- United States