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Defining pediatric trauma center resource utilization: Multidisciplinary consensus-based criteria from the Pediatric
Christopher W Snyder1, Karl O Kristiansen, Aaron R Jensen
1From the Division of Pediatric Surgery (C.W.S.), Johns Hopkins All Children's Hospital, St. Petersburg, Florida; Department of Anesthesia (K.O.K., M.E.C.), Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, New Hampshire; Division of Pediatric Surgery (A.R.J.), Benioff Children's Hospital, University of California-San Francisco, San Francisco, California; Department of Pediatric Neurosurgery (E.A.S.), Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Emergency Medicine (J.F.A.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatric Anesthesiology (C.X.C.), Seattle Children's Hospital, Seattle, Washington; and Department of Emergency Medicine (E.B.L.), University at Buffalo, Buffalo, New York.
Insights
This study establishes consensus criteria for pediatric trauma center (PTC) resource utilization. These criteria aim to improve pediatric trauma triage by better predicting the need for specialized PTC services.
Area of Science:
- Pediatric Trauma Care
- Medical Consensus Development
- Healthcare Systems Research
Background:
- Pediatric trauma triage decisions require assessing the likelihood of needing pediatric trauma center (PTC) resources.
- Resource utilization is a potentially more effective metric for pediatric injury severity than mortality risk.
- A standardized definition for PTC resource utilization is currently lacking.
Purpose of the Study:
- To develop multidisciplinary consensus-based criteria for defining pediatric trauma center (PTC) resource utilization.
- To establish a foundation for a resource-based pediatric injury severity metric.
- To enhance system-level pediatric trauma triage by identifying children likely to require PTC services.
Main Methods:
- A modified Delphi approach was employed, involving an 18-member expert panel from diverse pediatric disciplines.
- Criteria were drafted from a literature review and refined through three rounds of voting, requiring 75% consensus.
- Feedback was gathered from attendees at the Pediatric Trauma Society (PTS) annual meeting.
Main Results:
- Fourteen consensus criteria for PTC resource utilization were established from an initial 20 draft criteria.
- The criteria cover a broad spectrum of care, including airway management, resuscitation, surgical interventions, intensive care, and rehabilitation.
- The final criteria were endorsed by the PTS Guidelines Committee.
Conclusions:
- Multidisciplinary consensus criteria for pediatric trauma center (PTC) resource utilization have been defined.
- These criteria represent a significant advancement toward a standardized, resource-based pediatric injury severity metric.
- Optimizing pediatric trauma triage through better prediction of PTC resource needs is facilitated by these criteria.
Background:
Pediatric trauma triage and transfer decisions should incorporate the likelihood that an injured child will require pediatric trauma center (PTC) resources. Resource utilization may be a better basis than mortality risk when evaluating pediatric injury severity. However, there is currently no consensus definition of PTC resource utilization that encompasses the full scope of PTC services.
Methods:
Consensus criteria were developed in collaboration with the Pediatric Trauma Society (PTS) Research Committee using a modified Delphi approach. An expert panel was recruited representing the following pediatric disciplines: prehospital care, emergency medicine, nursing, general surgery, neurosurgery, orthopedics, anesthesia, radiology, critical care, child abuse, and rehabilitation medicine. Resource utilization criteria were drafted from a comprehensive literature review, seeking to complete the following sentence: "Pediatric patients with traumatic injuries have used PTC resources if they..." Criteria were then refined and underwent three rounds of voting to achieve consensus. Consensus was defined as agreement of 75% or more panelists. Between the second and third voting rounds, broad feedback from attendees of the PTS annual meeting was obtained.
Results:
The Delphi panel consisted of 18 members from 15 institutions. Twenty initial draft criteria were developed based on literature review. These criteria dealt with airway interventions, vascular access, initial stabilization procedures, fluid resuscitation, blood product transfusion, abdominal trauma/solid organ injury management, intensive care monitoring, anesthesia/sedation, advanced imaging, radiologic interpretation, child abuse evaluation, and rehabilitative services. After refinement and panel voting, 14 criteria achieved the >75% consensus threshold. The final consensus criteria were reviewed and endorsed by the PTS Guidelines Committee.
Conclusion:
This study defines multidisciplinary consensus-based criteria for PTC resource utilization. These criteria are an important step toward developing a criterion standard, resource-based, pediatric injury severity metric. Such metrics can help optimize system-level pediatric trauma triage based on likelihood of requiring PTC resources.
Level Of Evidence:
Diagnostic Test/Criteria; Level II.
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