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Pediatric Urgent Care Center Management of Traumatic Injuries in Infants and Children: Adherence to Evidence-Based
Paige C Chardavoyne1, Emily J Montgomery2, Amanda Montalbano2
1From the Penn State University College of Medicine, Hershey, PA.
Insights
Pediatric urgent care clinicians show good adherence to trauma guidelines but need improvement in managing severe head injuries and hemorrhage. Enhanced training and equipment, including Stop the Bleed, are recommended for better emergency preparedness.
Area of Science:
- Pediatric Emergency Medicine
- Urgent Care Practice
- Trauma Management
Background:
- Pediatric urgent care centers (PUCs) play a crucial role in managing acute pediatric trauma.
- Assessing adherence to evidence-based guidelines and emergency preparedness in PUCs is essential for optimal patient outcomes.
- Severe hemorrhage and complex head injuries present significant challenges in non-hospital settings.
Purpose of the Study:
- To evaluate the adherence of pediatric urgent care clinicians to evidence-based practice guidelines for pediatric trauma.
- To assess the emergency preparedness of PUCs for critical conditions like severe hemorrhage.
- To identify areas for improvement in trauma care within the pediatric urgent care setting.
Main Methods:
- A cross-sectional survey was electronically distributed to members of the Society for Pediatric Urgent Care.
- The questionnaire assessed the management of 15 pediatric traumatic injuries and awareness of the Stop the Bleed initiative.
- Clinician responses regarding management decisions were compared against established evidence-based practice guidelines.
Main Results:
- Eighty-three responses were analyzed, primarily from physicians and advanced practice providers (APPs).
- High adherence was observed for most common injuries, including fractures, burns, and uncomplicated lacerations.
- Lower adherence rates were noted for head injuries with altered mental status and lacerations with foreign bodies and persistent hemorrhage. Many clinicians were unaware of the Stop the Bleed initiative and lacked essential bleeding control equipment.
Conclusions:
- Pediatric urgent care providers demonstrate significant adherence to evidence-based guidelines for many pediatric trauma scenarios.
- There is a need to enhance trauma care certification, integrate Stop the Bleed education, and ensure adequate equipment availability in PUCs.
- Improving emergency preparedness in PUCs is crucial for effectively managing pediatric trauma, especially severe hemorrhage and complex head injuries.
Objectives:
To determine pediatric urgent care (PUC) clinician adherence to evidence-based practice guidelines in the management of pediatric trauma and to evaluate PUC emergency preparedness for conditions such as severe hemorrhage.
Methods:
A questionnaire covering acute management of 15 pediatric traumatic injuries, awareness of the Stop the Bleed initiative, and presence of emergency equipment and medications was electronically distributed to members of the Society for Pediatric Urgent Care. Clinician management decisions were evaluated against evidence-based practice guidelines.
Results:
Eighty-three completed questionnaires were returned (25% response rate). Fifty-three physician and 25 advanced practice provider (APP) questionnaires were analyzed. Most respondents were adherent to evidence-based practice guidelines in the following scenarios: cervical spine injury; head injury without neurologic symptoms; blunt abdominal injury; laceration without bleeding, foreign body, or signs of infection; first-degree burn; second-degree burn with less than 10% total body surface area; animal bite with and without probable tenosynovitis; and orthopedic fractures. Fever respondents were adherent in the following scenarios: head injury with altered mental status (adherence: physicians, 64%; APPs, 44%) and laceration with foreign body and persistent hemorrhage (adherence: physicians, 52%; APPs, 41%). Most respondents (56%) were unaware of Stop the Bleed and only 48% reported having a bleeding control kit/tourniquet at their urgent care.
Conclusions:
Providers in our sample demonstrated adherence with pediatric trauma evidence-based practice guidelines. Increased PUC provider trauma care certification, PUC incorporation of Stop the Bleed education, and PUC presence of equipment and medications would further improve emergency preparedness.
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