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Evidence-Informed Quality Indicators for Pediatric Trauma Care
Lynne Moore1,2, Natalie L Yanchar3, Pier-Alexandre Tardif4
1Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus), Québec, Québec, Canada.
Insights
A consensus developed 23 quality indicators (QIs) for pediatric trauma care. These evidence-based QIs address effectiveness, safety, and equity to improve care for children with injuries.
Area of Science:
- Pediatric Trauma Care
- Quality Improvement Science
- Health Services Research
Background:
- Pediatric trauma patients have unique needs, yet lack specific quality indicators (QIs) for improvement.
- Existing quality metrics may not adequately address the complexities of pediatric trauma care.
Purpose of the Study:
- To establish a consensus-based set of QIs for acute pediatric trauma care.
- To ensure QIs are evidence-based, considering effectiveness, safety, cost-effectiveness, equity, and caregiver perspectives.
- To develop QIs applicable across diverse trauma center settings.
Main Methods:
- A modified RAND/UCLA expert consensus study involving surveys and a virtual workshop.
- Inclusion of diverse panelists: pediatric trauma experts, various care settings, international representation, and caregivers.
- Analysis of 41 potential QIs rated on importance, evidence, actionability, and measurability.
Main Results:
- Fifty-nine experts participated, with 54 completing the consensus process.
- Twenty-three QIs were selected, covering neurotrauma, vital signs, rehabilitation, nutrition, specific injuries (TBI, fractures, solid organ), imaging, patient-centered care, and equity.
- Selected QIs focus on areas like transfer protocols, documentation, early interventions, and patient/caregiver support.
Conclusions:
- The developed QIs provide a foundation for quality improvement in pediatric trauma care.
- These indicators can enhance the effectiveness, safety, cost-effectiveness, and equity of care for injured children.
- The consensus-based approach ensures relevance and applicability in various high-resource trauma settings.
Importance:
Despite the unique physiological characteristics and health care needs of pediatric trauma patients, there is a lack of quality indicators (QIs) based on pediatric-specific evidence to support quality improvement in this population.
Objective:
To develop a consensus-based set of QIs for acute pediatric trauma care that considers evidence on effectiveness, safety, cost-effectiveness, equity, and caregiver perspectives and is applicable in pediatric and nonpediatric trauma centers.
Design, Setting, And Participants:
A modified Research and Development (RAND)/University of California Los Angeles (UCLA) expert consensus study was conducted consisting of an online survey and a virtual workshop, led by an independent moderator. Panelists represented key areas of pediatric trauma patient management, diverse care settings (from level I pediatric trauma centers to level III referring centers), 5 high-resource countries, and caregivers. Data were analyzed from May to August 2024.
Exposure:
Likert-scale ratings of 41 QIs.
Main Outcomes And Measures:
Panelists rated 41 QIs on a 7-point Likert scale according to 4 criteria: importance, supporting evidence, actionability, and measurability. QIs with a global score of 24 of 28 or greater and an importance score of 6 of 7 or greater were considered accepted by consensus.
Results:
A total of 65 experts were invited, of whom 59 accepted (91%; 25 over 50 years of age [44.7%]; 34 female [60.7%]), 56 (95%) completed the first round, and 54 (92%) completed both rounds. Twenty-three QIs were selected covering key areas of acute pediatric trauma management (eg, transfer to a pediatric trauma center for neurotrauma or major multisystem trauma, documentation of vital signs, early rehabilitation, nutritional support), the most common types of injuries (eg, hypertonic saline in severe traumatic brain injury, stabilization of femoral shaft fractures, nonoperative management of solid organ injuries), value in care (eg, imaging in children at low risk on a clinical decision rule), patient-centered care (eg, designated support person, caregiver presence), and equity (eg, mental health screening).
Conclusions:
These results may be used by trauma quality improvement programs in high-resource countries to select context-specific quality indicators to improve the effectiveness, safety, cost-effectiveness, equity, and patient-centered nature of pediatric trauma care.
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