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Войти в исследования Evidence-Informed Quality Indicators for Pediatric Trauma Care.
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Moore Lynne, Yanchar Natalie L, Tardif Pier-Alexandre, Weiss Matthew, Beaulieu Emilie, Stang Antonia, Gagnon Isabelle, Gabbe Belinda, Stelfox Thomas, Pike Ian, Macpherson Alison, Berthelot Simon, Klassen Terry, Beno Suzanne, Carsen Sasha, Labrosse Mélanie, Zemek Roger, Priestap Fran, Burstein Brett, Remick Katherine E, Yeates Keith Owen, Merritt Neil, Kuppermann Nathan, Loellgen Ruth, Davis Naomi, Lecky Fiona, Teague Warwick, Holland Andrew, Malo Christian, Beaudin Marianne, Archambault Patrick, Freire Gabrielle, Quality Indicators in Pediatric Trauma Care Expert Consensus Group
Аннотация
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.