Determining a Consensus-Based Measure for Critical Illness and Injury for Children Cared for By Emergency Medical...

Area of Science:

• Emergency Medicine
• Critical Care
• Health Services Research

Background:

• Accurate triage of critically ill or injured patients from the field or community emergency departments (EDs) is crucial for effective emergency, disaster, and surge response.
• Developing standardized, hospital-based outcome measures is essential for improving prehospital emergency medical services (EMS) models.

Purpose of the Study:

• To define a consensus-based, hospital-based measure of critical illness and/or injury.
• To support the development of EMS-based models for predicting critical outcomes in patients, particularly children.

Main Methods:

• Convened a 22-member Delphi panel of diverse clinical specialists (pediatrics, emergency medicine, surgery, trauma, prehospital medicine, EMS).
• Utilized a modified Delphi process with sequential voting rounds to establish consensus on diagnostic, intervention, and clinical outcome criteria.
• Achieved high participation rates (95-100%) across four voting rounds.

Main Results:

• Achieved consensus on 50 specific measures, encompassing medical diagnoses (8), trauma diagnoses (14), trauma mechanisms (1), assessments (6), interventions (13), medications (6), and dispositions (2).
• A final consensus of 82% was reached on the defined criteria.
• The study successfully identified key indicators for critical illness and/or injury in a hospital setting.

Conclusions:

• Consensus was reached on operational, hospital-based outcome criteria for critical illness and/or injury.
• This framework facilitates future benchmarking of EMS performance and precise identification of at-risk children in prehospital settings.
• Next steps involve assessing criterion prevalence in various hospital settings and developing prediction models for prehospital factors.