Effects of Implementing a Standardized Surveillance Program on Cardiac Neurodevelopmental Program Referral Completion.

Differences in surveillance methods have resulted in significant variability in referral volumes and referral completion rates across cardiac neurodevelopmental programs, with frequent barriers to referral completion including high no-show rates, lack of education, and inaccessibility for underrepresented populations. The purpose of this study was to describe implementation of a standardized surveillance program and investigate impact on referral volume and completion over a two-year period. Between fiscal years 2021 and 2022, a surveillance program was implemented which standardized assessment of neurodevelopmental risk via a checklist as well as family education and referral procedures. All patients referred to the cardiac neurodevelopmental program during these two fiscal years were included in the analysis, and patient referrals were categorized as complete or incomplete (due to physician-related or patient-related factors). Referral completion rates between fiscal years were compared using two sample Z test of proportions, while associations between referral completion and demographic/anatomical variables were completed using chi-square tests of independence. Implementation of the formal surveillance program resulted in a 66.7% increase in referral volume. Proportions of both incomplete referrals (z = 2.00, p < 0.05) and incomplete referrals due to physician-related factors (z = 4.34, p < 0.01) were significantly lower after implementation. A significant association was found after implementation between referral completion and race/ethnicity (x2 = 14.08, p < 0.01) due to a significantly high proportion of completed referrals for patients identifying as Hispanic/Latino within the overall distribution of patients. This study describes the successful implementation of a standardized surveillance program, including improvements to referral volume and completion rate. Findings also support implementation of methods that emphasize physician surveillance methods and improve accessibility for historically marginalized groups at greatest risk for disparities in access and quality of care.

Postconcussive symptom report in polytrauma: influence of mild traumatic brain injury and psychiatric distress.

Many studies have evaluated the influence of mild traumatic brain injury (mTBI) on neuropsychological test performance and on report of postconcussive symptoms. However, most studies that examine postconcussion syndrome (PCS) do not address the issue of "polytrauma," which is common in military mTBI. This study investigated simultaneously demographic, injury-related, and psychiatric symptom predictors of PCS report in a veteran, polytrauma sample. In prediction of overall report of PCS symptoms with demographic, traumatic brain injury, psychiatric and sleep variables, 60% of the variance was explained. Semipartial correlations revealed that post-traumatic stress disorder uniquely explained 7% of the variance, depression 2%, and sleep dissatisfaction 3%; injury and demographic characteristics accounted for no unique variance. In all 5 hierarchical multiple regressions (prediction of total Neurobehavioral Symptom Inventory score and 4 individual factor scores), the total models were significant (p < 0.001). Accurate diagnosis and treatment necessitates an integrative analysis of PCS, psychiatric, behavioral, and health symptom report in addition to neuropsychological functioning in the polytrauma population. This study demonstrated that emotional distress was uniquely predictive of total report of PCS and that no injury-related characteristics were predictive. This is of particular relevance in a Veteran population given the high rates of both mTBI and psychiatric disturbance.