Faculty Collaboration Database

Variability in the structure and care processes for critically injured children: A multicenter survey of trauma bay and intensive care units. J Pediatr Surg 2016 Mar;51(3):490-8

Date

10/11/2015

Pubmed ID

26452704

DOI

10.1016/j.jpedsurg.2015.09.006

Scopus ID

2-s2.0-84960092441 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

PURPOSE: Evaluate national variation in structure and care processes for critically injured children.

METHODS: Institutions with pediatric intensive care units (PICUs) that treat trauma patients were identified through the Virtual Pediatric Systems (n=72). Prospective survey data were obtained from PICU and Trauma Directors (n=69, 96% response). Inquiries related to structure and care processes in the PICU and emergency department included infrastructure, physician staffing, team composition, decision making, and protocol/checklist use.

RESULTS: About one-third of the 69 institutions were ACS-verified Level-1 Pediatric Trauma Centers (32%); 36 (52%) were state-designated Level 1. The surgeon was the primary decision maker in the trauma bay at 88% of sites, and in the PICU at 44%. The intensivist was primary in the PICU at 30% of sites and intensivist consultation was elective at 11%. Free-standing pediatric centers used checklists more often than adult/pediatric centers for DVT prophylaxis (75% vs. 50%, p=0.039), cervical spine clearance (75% vs. 44%, p=0.011), and pain control (63% vs. 34%, p=0.024). Otherwise, protocols/checklists were infrequently utilized by either center type.

CONCLUSION: Variability exists in structure and care processes for critically injured children. Further investigation of variation and its causal relationship to outcomes is warranted to provide optimal care.

Author List

Flynn-O'Brien KT, Thompson LL, Gall CM, Fallat ME, Rice TB, Rivara FP

Author

Katherine T. Flynn-O'Brien MD, MPH Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Critical Care
Emergency Medical Services
Female
Health Care Surveys
Healthcare Disparities
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Male
Prospective Studies
Trauma Centers
United States
Wounds and Injuries