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Development, implementation and prospective evaluation of guidelines for transfer of severely injured children to
M Patterson1, M Jones, D A Lloyd
1Department of Paediatric Surgery, Royal Liverpool Children's NHS Trust, Alder Hey, and Department of Child Health, University of Liverpool, Liverpool, UK.
Insights
Developing triage guidelines for injured children significantly improved transfer rates to specialist centers. This enhanced management for severely injured pediatric patients, ensuring timely and appropriate care.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Healthcare Management
Background:
- Most injured children receive adequate care at district general hospitals (DGHs).
- Some critically injured children require transfer to specialized pediatric trauma centers.
- Effective triage is crucial for timely transfer and optimal outcomes.
Purpose of the Study:
- To develop, implement, and evaluate triage guidelines for identifying injured children needing transfer.
- To improve the recognition and management of severely injured pediatric patients.
- To assess the impact of guidelines on referral and management patterns.
Main Methods:
- Prospective, interventional cohort study involving 592 seriously injured children over 51 months.
- Development and implementation of guidelines by a multispecialty steering group.
- Data collection over 24 months pre-guidelines, 3 months implementation, and 24 months post-guidelines.
Main Results:
- A 29% increase in transfers to specialist centers for unstable (Level I) patients post-guidelines (68% to 97%).
- Elimination of DGH intensive care unit admissions for these patients.
- All major surgical interventions for these patients were performed at specialist centers.
Conclusions:
- Introduction of triage guidelines, coupled with effective communication, altered the management of severely injured children.
- Guidelines facilitated appropriate patient disposition, increasing specialist center utilization.
- The study demonstrated the effectiveness of structured triage in pediatric trauma care.
Background:
Most injured children are appropriately treated at a district general hospital (DGH), but some require transfer to a specialist centre. The objectives of this study were to develop, implement and evaluate triage guidelines for the rapid recognition of injured children who require transfer.
Methods:
This was a prospective, interventional cohort study of the 592 seriously injured children who presented to five regional DGHs during a 51-month period. A multispecialty steering group representing all participating DGHs developed and implemented the guidelines. Data were collected for 24 months before the guidelines were introduced, over the 3-month implementation period and for 24 months afterwards. Outcome measures were referral and management patterns before and after introduction of the guidelines.
Results:
For level I (unstable) patients, after the implementation of guidelines there was a 29 per cent increase in the proportion of transfers to a specialist centre (from 40 (68 per cent) of 59 to 32 (97 per cent) of 33; P = 0.003), no admissions to a DGH intensive care unit and all 12 operations were performed at a specialist centre. Guideline users indicated that they were familiar with the guidelines.
Conclusion:
The introduction of triage guidelines within an effective communication network was associated with changes in the management of severely injured children.
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