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

Accurate triage of patients from the field or community EDs to higher levels of care is essential for emergency, disaster, and surge response. We sought to define a hospital-based measure of critical illness and/or injury to support the development of emergency medical services-based models for this outcome.

We convened a 22-member Delphi panel of clinicians with subspecialities including pediatrics, pediatric emergency medicine, pediatric surgery, trauma, prehospital medicine, and emergency medical services. We considered key diagnostic, intervention, and clinical outcome criteria for patients following arrival to the hospital to determine a consensus-based measure for critical illness and/or injury. We engaged in a modified Delphi process with sequential rounds of voting to determine consensus priorities.

We completed 4 rounds of voting, with participation ranging between 95% and 100% on each round. We achieved consensus on 50 measures, including for 8 medical diagnoses, 14 trauma diagnoses, 1 trauma mechanism, 6 assessments, 13 interventions, 6 medications, and 2 dispositions. In the final survey, we achieved a consensus of 82%.

We reached consensus on measures for an operational hospital-based outcome criteria for critical illness and/or injury. This approach also enables future benchmarking of EMS performance and more precise identification of at-risk children in the prehospital setting. Subsequent steps include determining the prevalence of these criteria within varying hospital-based settings and the development of prediction models to identify prehospital factors associated with these outcomes.