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Pediatric triage and allocation of critical care resources during disaster: Northwest provider opinion
Erin Margaret Johnson1, Douglas S Diekema2, Mithya Lewis-Newby2
11Children's Hospital of Pittsburgh,Pittsburgh,PennsylvaniaUSA.
Insights
Pediatric critical care providers need a standardized disaster triage system. Most surveyed preferred prioritizing children with good neuro-cognitive outcomes, with differing views based on work location.
Area of Science:
- Disaster Medicine
- Pediatric Critical Care
- Public Health Policy
Background:
- Following Hurricane Katrina and the H1N1 epidemic, a need for a standardized pediatric triage and allocation system was identified.
- Pediatric critical care clinicians recognized the urgency for a structured approach to care allocation during mass casualty events.
Purpose of the Study:
- To collect regional provider opinions on care allocation and pediatric triage in disaster or pandemic scenarios.
- To assess healthcare provider perspectives on ethical and logistical issues in pediatric disaster triage.
Main Methods:
- A cross-sectional survey was conducted among US healthcare providers and public health workers interested in critical care or disaster medicine.
- Participants attended a 2012 pediatric critical care symposium on disaster preparation.
- An electronic audience response system was used, with data analyzed using chi-square tests to compare opinions based on profession and work location.
Main Results:
- Of 116 attendees, 112 responded. 55% were nurses, 26% physicians. 51% worked in pediatric hospitals.
- 58% prioritized children with predicted good neuro-cognitive outcomes; 68% agreed no pediatric age group should be prioritized.
- Providers in non-pediatric hospitals were more likely to prefer an objective score-based triage system (43%) compared to those in pediatric hospitals (26%, P = .038).
Conclusions:
- Provider opinions on pediatric triage during disasters vary, particularly concerning prioritization criteria and the role of objective scoring systems.
- The findings highlight the need for a consensus-based, standardized pediatric triage system for mass casualty events.
- Further research and discussion are needed to develop and implement effective pediatric disaster allocation strategies.
Introduction:
Following Hurricane Katrina and the 2009 H1N1 epidemic, pediatric critical care clinicians recognized the urgent need for a standardized pediatric triage/allocation system. This study collected regional provider opinion on issues of care allocation and pediatric triage in a disaster/pandemic setting.
Methods:
This study was a cross-sectional survey of United States (US) health care providers and public health workers who demonstrated interest in critical care and/or disaster care medicine by attending a Northwest regional pediatric critical care symposium on disaster preparation, held in 2012 at Seattle Children's Hospital in Seattle, Washington (USA). The survey employed an electronic audience response system and included demographic, ethical, and logistical questions. Differences in opinions between respondents grouped by professions and work locations were evaluated using a chi-square test.
Results:
One hundred and twelve (97%) of 116 total attendees responded to at least one question; however, four of these responders failed to answer every question. Sixty-two (55%) responders were nurses, 29 (26%) physicians, and 21 (19%) other occupations. Fifty-five (51%) responders worked in pediatric hospitals vs 53 (49%) in other locations. Sixty-three (58%) of 108 successful responses prioritized children predicted to have a good neuro-cognitive outcome. Seventy-one (68%) agreed that no pediatric age group should be prioritized. Twenty-two (43%) of providers working in non-pediatric hospital locations preferred a triage system based on an objective score alone vs 14 (26%) of those in pediatric hospitals (P = .038).
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