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Delphi Process for Validation of Fluid Treatment Algorithm for Critically Ill Pediatric Trauma Patients
Vincent Duron1, Nicholas Schmoke1, Rika Ichinose1
1Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
Insights
Pediatric trauma patients benefit from a new fluid management algorithm that prioritizes de-escalating intravenous fluids to minimize complications. This consensus-based approach ensures expert agreement on optimal crystalloid resuscitation strategies.
Area of Science:
- Pediatric Critical Care
- Trauma Resuscitation
- Fluid Management
Background:
- Intravenous fluid therapy is crucial for pediatric trauma patients but aggressive resuscitation carries risks.
- Optimal crystalloid resuscitation strategies and fluid phase transitions lack consensus.
- Minimizing iatrogenic complications from fluid therapy is a key concern.
Purpose of the Study:
- To develop and validate a consensus-based algorithm for intravenous fluid management in pediatric trauma.
- To establish clear guidelines for fluid resuscitation de-escalation in this population.
Main Methods:
- A three-round Delphi process involving 14 pediatric trauma, critical care, and emergency medicine experts.
- Online surveys and live video conferences were used to achieve expert consensus.
- Algorithm parameters were accepted if >75% agreed or rejected if >50% disagreed.
Main Results:
- Initial expert agreement was 64%, increasing to 90% after round 2.
- The final revised algorithm achieved 100% acceptance from all participating experts.
- Fourteen experts from five Level 1 pediatric trauma centers participated.
Conclusions:
- A validated algorithm for fluid management in pediatric trauma patients has been developed.
- The algorithm emphasizes de-escalation of intravenous fluids to reduce iatrogenic complications.
- This consensus-driven approach provides a standardized method for fluid therapy in pediatric trauma.
Introduction:
While intravenous fluid therapy is essential to re-establishing volume status in children who have experienced trauma, aggressive resuscitation can lead to various complications. There remains a lack of consensus on whether pediatric trauma patients will benefit from a liberal or restrictive crystalloid resuscitation approach and how to optimally identify and transition between fluid phases.
Methods:
A panel was comprised of physicians with expertise in pediatric trauma, critical care, and emergency medicine. A three-round Delphi process was conducted via an online survey, with each round being followed by a live video conference. Experts agreed or disagreed with each aspect of the proposed fluid management algorithm on a five-level Likert scale. The group opinion level defined an algorithm parameter's acceptance or rejection with greater than 75% agreement resulting in acceptance and greater than 50% disagreement resulting in rejection. The remaining were discussed and re-presented in the next round.
Results:
Fourteen experts from five Level 1 pediatric trauma centers representing three subspecialties were included. Responses were received from 13/14 participants (93%). In round 1, 64% of the parameters were accepted, while the remaining 36% were discussed and re-presented. In round 2, 90% of the parameters were accepted. Following round 3, there was 100% acceptance by all the experts on the revised and final version of the algorithm.
Conclusions:
We present a validated algorithm for intavenous fluid management in pediatric trauma patients that focuses on the de-escalation of fluids. Focusing on this time point of fluid therapy will help minimize iatrogenic complications of crystalloid fluids within this patient population.
