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Developing a clinical decision tool to support paramedics when assessing and managing children with minor head injury
Alyesha Proctor1, Mark D Lyttle2,3, Sarah Voss2
1Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus (1H30), Blackberry Hill, Stapleton, Bristol, BS16 1DD, UK. Alyesha.proctor@uwe.ac.uk.
Insights
A new pre-hospital tool, PATCH, was developed with expert consensus to help paramedics assess and manage children with minor head injuries, improving pre-hospital care.
Area of Science:
- Pediatric Emergency Medicine
- Pre-hospital Care
- Clinical Decision Support Tools
Background:
- Head-injured children frequently require ambulance transport to the Emergency Department (ED).
- Most pediatric head injury cases are non-serious and discharged after triage.
- Existing clinical decision tools are primarily for in-hospital use to determine CT scan necessity, not for pre-hospital assessment by paramedics.
Purpose of the Study:
- To achieve expert and stakeholder consensus for developing a pre-hospital clinical decision tool.
- To support paramedics in the safe assessment and management of children with minor head injuries at the scene.
- To inform the creation of a novel pre-hospital assessment tool for pediatric head injuries.
Main Methods:
- A modified online Delphi technique involving two rounds and a consensus meeting was employed.
- Consensus was measured using a 5-point Likert scale, with a pre-defined threshold of 67%.
- Data analysis included free-text responses and anonymous feedback after each Delphi round.
Main Results:
- A diverse expert stakeholder group (36 participants in Round 1, 34 in Round 2) including parents, paramedics, and clinicians participated.
- Consensus was achieved on 36 statements after the two online Delphi rounds.
- Seven out of eight statements were agreed upon during the final consensus meeting.
Conclusions:
- Consensus was established on the content and format of a pre-hospital pediatric head injury clinical decision tool for paramedics.
- The developed tool is named PATCH (Pre-hospital Assessment Tool for Children with Head injury).
- Future research should focus on evaluating the acceptability and usability of the PATCH tool by paramedics.
Background:
Head-injured children are commonly transported to the Emergency Department (ED) by ambulance. However, most of those conveyed are deemed non-serious and are discharged at triage. Hospital clinicians use clinical decision tools to support their assessment of head-injured children; however, this is generally to determine whether a computed tomography (CT) scan is indicated. Currently, there is no pre-hospital clinical decision tool designed to support paramedics when assessing and managing head-injured children at scene. The aim of this study was to determine consensus amongst experts and stakeholders to inform the development of a new tool to support paramedics in safely assessing and managing children with minor head injury.
Methods:
A consultation process using a modified online Delphi technique comprising two rounds and a consensus meeting was completed between September 2023 and January 2024. A 5-point Likert scale was used to assess consensus, set a-priori at 67%. Free text survey responses arising from the Delphi were studied and concepts were developed. Data were analysed anonymously, and feedback was given after each round.
Results:
An expert stakeholder group comprising 36 participants took part in Round One, and 34 participants in Round Two of the online Delphi. The participants included parents/grandparents/caregivers, paramedics, primary care clinicians, ED doctors, ED nurses and Paediatricians. Consensus was reached in 36 statements following Rounds One and Two. The remaining eight statements were discussed at a consensus meeting, which was attended by 12 stakeholders. Seven of the eight statements reached agreement.
Conclusion:
This Delphi study has established consensus amongst a group of experts and stakeholders on the content and format of a pre-hospital paediatric head injury clinical decision tool, designed for use by paramedics: PATCH (Pre-hospital Assessment Tool for Children with Head injury). Future research should include an evaluation of the acceptability and usability of PATCH by paramedics.
Clinical Trial Number:
Not applicable.
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