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1. Creating a Pediatric Prehospital Destination Decision Tool Using a Modified Delphi Method

Author

Jennifer F. Anders, Jennifer N. Fishe, Kyle A. Fratta, Jessica H. Katznelson, Matthew J. Levy, Richard Lichenstein, Michael G. Milin, Joelle N. Simpson, Theresa A. Walls, and Heather L. Winger

Subjects
emergency medical services (EMS), prehospital, pediatrics, emergency care, triage, transport, Pediatrics, RJ1-570
Abstract

Decisions for patient transport by emergency medical services (EMS) are individualized; while established guidelines help direct adult patients to specialty hospitals, no such pediatric equivalents are in wide use. When children are transported to a hospital that cannot provide definitive care, care is delayed and may cause adverse events. Therefore, we created a novel evidence-based decision tool to support EMS destination choice. A multidisciplinary expert panel (EP) of stakeholders reviewed published literature. Four facility capability levels for pediatric care were defined. Using a modified Delphi method, the EP matched specific conditions to a facility pediatric-capability level in a draft tool. The literature review and EP recommendations identified seventeen pediatric medical conditions at risk for secondary transport. In the first voting round, two were rejected, nine met consensus for a specific facility capability level, and six did not reach consensus on the destination facility level. A second round reached consensus on a facility level for the six conditions as well as revision of one previously rejected condition. In the third round, the panel selected a visual display format. Finally, the panel unanimously approved the PDTree. Using a modified Delphi technique, we developed the PDTree EMS destination decision tool by incorporating existing evidence and the expertise of a multidisciplinary panel.

Published
2021
Full Text
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2. Contributors

Author

Ayesha Abid, Spencer A. Adoff, Tabassum F. Ali, Siraj Amanullah, Adae Amoako, Jennifer F. Anders, Nadine Aprahamian, Jeffrey R. Avner, Michael C. Bachman, Richard G. Bachur, Jennifer Bellis, Craig F. Betchart, Harsh Bhakta, Toral Bhakta, Lauren E. Borowski, Jodi Brady-Olympia, Kathryn S. Brigham, Jeffrey I. Campbell, Therese L. Canares, Steven Chan, Bradley Chappell, Joel M. Clingenpeel, Jeff Cloyd, Ariel Cohen, Douglas Comeau, Ryan Cudahy, Kaynan Doctor, Jennifer Dunnick, Michele J. Fagan, Daniel M. Fein, Fidel Garcia Fernandez, Jennifer Fishe, Sylvia E. Garcia, Timothy J. Gill, Scott Goldstein, Bryan Greenfield, Vernne W. Greiner, Maya Haasz, Selena Hariharan, Kristin Herbert, Bruce E. Herman, Sixtine Valdelièvre Herold, Crystal M. Higginson, Toni Clare Hogencamp, Bret C. Jacobs, Leah Kaye, Abbie Kelley, Alicia Kenton, Brian Kipe, Steven J. Kleinman, Atsuko Koyama, Karen Y. Kwan, Mark E. Lavallee, Duron A. Lee, Susannah Lichtenstein, Laura J. Lintner, Jayson Loeffert, Todd Mastrovitch, Sarah D. Meskill, Christopher M. Miles, Mark H. Mirabelli, Ariella Nadler, Ariel Nassim, Yashas Nathani, Chadd E. Nesbit, Anne M. O’Connor, Robert P. Olympia, Rory M. O’Neill, Cayce Onks, John A. Park, Jay Pershad, Nicholas Pfeifer, Christopher M. Pruitt, George G.A. Pujalte, Joni E. Rabiner, Eric Requa, Lilia Reyes, Ruby F. Rivera, Jeffrey A. Rixe, Emily Rose, Jerri A. Rose, Timothy Salkauskis, Esther Maria Sampayo, Jennifer E. Sanders, Sandra K. Schumacher, Kara K. Seaton, Peter H. Seidenberg, Alexander Y. Sheng, Matthew L. Silvis, Samantha F. Singer, Lindsay A. Smith, Joseph Spinell, Ee Tein Tay, Heath C. Thornton, Thomas H. Trojian, Peggy Tseng, Bryan D. Upham, Michelle N. Vazquez, Jeffrey A. Waskin, Robert D. Wilkinson, Robert B. Windsor, and Daniel Ta Yo Yu

Published
2018

3. Comparison of outcomes for children with cervical spine injury based on destination hospital from scene of injury

Author

Jennifer F, Anders, Kathleen, Adelgais, John D, Hoyle, Cody, Olsen, David M, Jaffe, Julie C, Leonard, and J, Wright

Subjects
Male, Patient Transfer, medicine.medical_specialty, Emergency Medical Services, Adolescent, Specialty, Psychological intervention, Cervical spine injury, Time-to-Treatment, Injury Severity Score, Altered Mental Status, Hospital Administration, Trauma Centers, Outcome Assessment, Health Care, medicine, Emergency medical services, Humans, Child, business.industry, General Medicine, Odds ratio, medicine.disease, Transportation of Patients, Treatment Outcome, Spinal Injuries, Child, Preschool, Emergency medicine, Cohort, Emergency Medicine, Physical therapy, Cervical Vertebrae, Female, business, Pediatric trauma
Abstract

BACKGROUND: Pediatric cervical spine injury is rare. As a result, evidence-based guidance for prehospital triage of children with suspected cervical spine injuries is limited. The effects of transport time and secondary transfer for specialty care have not previously been examined in the subset of children with cervical spine injuries. OBJECTIVES: The primary objective was to determine if prehospital destination choice affects outcomes for children with cervical spine injuries. The secondary objectives were to describe prehospital and local hospital interventions for children ultimately transferred to pediatric trauma centers for definitive care of cervical spine injuries. METHODS: The authors searched the Pediatric Emergency Care Applied Research Network (PECARN) cervical spine injury data set for children transported by emergency medical services (EMS) from scene of injury. Neurologic outcomes in children with cervical spine injuries transported directly to pediatric trauma centers were compared with those transported to local hospitals and later transferred to pediatric trauma centers, adjusting for injury severity, indicated by altered mental status, focal neurologic deficits, and substantial comorbid injuries. In addition, transport times and interventions provided in the prehospital, local hospital, and pediatric trauma center settings were compared. Multiple imputation was used to handle missing data. RESULTS: The PECARN cervical spine injury cohort contains 364 patients transported from scene of injury by EMS. A total of 321 met our inclusion criteria. Of these, 180 were transported directly to pediatric trauma centers, and 141 were transported to local hospitals and later transferred. After adjustments for injury severity, odds of a normal outcome versus death or persistent neurologic deficit were higher for patients transported directly to pediatric trauma centers (odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.03 to 3.47). EMS transport times to first hospital did not differ and did not affect outcomes. Prehospital analgesia was very infrequent. CONCLUSIONS: Initial destination from scene (pediatric trauma center vs. local hospital) appears to be associated with neurologic outcome of children with cervical spine injuries. Markers of injury severity (altered mental status and focal neurologic findings) are important predictors of poor outcome in children with cervical spine injuries and should remain the primary guide for prehospital triage to designated trauma centers. Language: en

Published
2013

4. Contributors

Author

Michael K. Abraham, Fredrick M. Abrahamian, Mohammed A. Abu Aish, Bruce D. Adams, James G. Adams, Nima Afshar, James Ahn, Amer Z. Aldeen, Paul J. Allegretti, Jennifer F. Anders, Jana L. Anderson, Phillip Andrus, Christian Arbelaez, Charles B. Arbogast, Chandra D. Aubin, Jennifer Avegno, John Bailitz, Patricia Baines, Aaron E. Bair, Katherine Bakes, Aaron N. Barksdale, William G. Barsan, Erik D. Barton, Benjamin S. Bassin, Craig G. Bates, Jamil D. Bayram, Tomer Begaz, Kip Benko, Kavita Bhanot, Kriti Bhatia, Paul D. Biddinger, Andra L. Blomkalns, John M. Boe, J. Stephen Bohan, Keith Boniface, Laura J. Bontempo, Pierre Borczuk, Keith Borg, Nicholas A. Borm, Philip Bossart, Megan Boysen Osborn, William J. Brady, Jeremy B. Branzetti, Bart S. Brown, David F.M. Brown, Sean M. Bryant, John H. Burton, Christine Butts, Mark W. Byrne, Daniel Cabrera, Robert D. Cannon, David A. Caro, Christopher R. Carpenter, Wallace A. Carter, Cindy W. Chan, Gar Ming Chan, Andrew K. Chang, Douglas M. Char, Navneet Cheema, Yi-Mei Chng, Michael R. Christian, Richard F. Clark, Kathleen J. Clem, James E. Colletti, Jamie L. Collings, Christopher B. Colwell, Justin Cook, Jeremy L. Cooke, Julie J. Cooper, D. Mark Courtney, Kirk L. Cumpston, Rita K. Cydulka, Lynda Daniel-Underwood, Elizabeth M. Datner, Jonathan E. Davis, Virgil Davis, Mae F. De La Calzada-Jeanlouie, Sarah Steward de Ramirez, Peter M.C. DeBlieux, Wyatt W. Decker, Jorge del Castillo, John Deledda, Eva M. Delgado, M. Kit Delgado, Margaret M. DiGeronimo, Gail D’Onofrio, Gerard S. Doyle, Bradley A. Dreifuss, Jeffrey Druck, Jonathan A. Edlow, Jeffrey M. Elder, Kirsten G. Engel, Ugo A. Ezenkwele, Jessica A. Fulton, Fiona E. Gallahue, Manish Garg, Gus M. Garmel, Ryan T. Geers, Carl A. Germann, Chris A. Ghaemmaghami, Michael A. Gibbs, Gregory H. Gilbert, Michael A. Gisondi, Steven A. Godwin, Joshua N. Goldstein, Eric Goralnick, Deepi G. Goyal, Matthew N. Graber, David D. Gummin, Geetika Gupta, Todd A. Guth, Azita G. Hamedani, Abigail D. Hankin, Benjamin P. Harrison, Stephen C. Hartsell, Tarlan Hedayati, Alan C. Heffner, Diane B. Heller, Robin R. Hemphill, Gregory L. Henry, H. Gene Hern, Sheryl L. Heron, Cherri D. Hobgood, Beatrice Hoffmann, Lance H. Hoffman, Christy Hopkins, Russ Horowitz, Debra E. Houry, David S. Howes, J. Stephen Huff, James Q. Hwang, Eric Isaacs, Benjamin F. Jackson, Andy Jagoda, Edward C. Jauch, Kerin A. Jones, Randall S. Jotte, Christopher S. Kang, Jacqueline Khorasanee, Christopher S. Kiefer, Tae Eung Kim, Heidi H. Kimberly, Matthew Kippenhan, Niranjan Kissoon, Kevin Klauer, Frederick Korley, Joshua M. Kosowsky, Karen Nolan Kuehl, Thomas Kunisaki, Shana Kusin, Michael Lambert, Patrick M. Lank, Erin M. Lareau, Sara Lary, Erik G. Laurin, Holly K. Ledyard, Eric L. Legome, Tracy Leigh LeGros, Katrina A. Leone, Matthew R. Levine, Michael Levine, Jason E. Liebzeit, Michelle Lin, M. Scott Linscott, Suzanne Lippert, John B. Lissoway, Robert Lockwood, Heather Long, Dave W. Lu, Binh T. Ly, Catherine A. Lynch, Troy E. Madsen, Swaminatha V. Mahadevan, Mamta Malik, Haney A. Mallemat, Michael P. Mallin, Gerald Maloney, Nicole Malouf, Rita A. Manfredi, David E. Manthey, Keith A. Marill, Melissa Marinelli, Joseph P. Martinez, Amal Mattu, Anna K. McFarlin, Mark McIntosh, Candace D. McNaughton, Ron Medzon, Carl R. Menckhoff, Glen E. Michael, Nathan W. Mick, Lisa D. Mills, Trevor J. Mills, Peter P. Monteleone, Raveendra S. Morchi, Lisa Moreno-Walton, Elizabeth A. Mort, Thomas Morrissey, Heather Murphy-Lavoie, Mark B. Mycyk, Eric S. Nadel, Swathi Nadindla, Brian K. Nelson, Lewis S. Nelson, Sara W. Nelson, David H. Newman, Bret A. Nicks, Vicki E. Noble, Joshua N. Nogar, Robert L. Norris, Ashley Booth Norse, Robert E. O’Connor, Kelly P. O’Keefe, Haru Okuda, Brian W. Patterson, Leigh A. Patterson, Richard Paula, Joseph F. Peabody, David A. Peak, John Nelson Perret, Andrew D. Perron, Vanessa Maria Piazza, Robert F. Poirier, Emilie S. Powell, Susan B. Promes, Tammie E. Quest, James Quinn, Claudia Ranniger, Niels K. Rathlev, James W. Rhee, Keri Robertson, Matthew T. Robinson, Robert L. Rogers, Carlo L. Rosen, Christopher Ross, Scott E. Rudkin, Anne-Michelle Ruha, Michael S. Runyon, Annie T. Sadosty, Tracy G. Sanson, Jairo I. Santanilla, Sally A. Santen, Osman R. Sayan, Michael J. Schmidt, Kathleen S. Schrank, Jeremiah D. Schuur, Theresa Schwab, Wesley H. Self, Monique I. Sellas, Andrew W. Shannon, Ghazala Q. Sharieff, Rahul Sharma, Philip Shayne, Ashley Shreves, Amandeep Singh, Ellen M. Slaven, Mark Sochor, Mitchell C. Sokolosky, Jeremy D. Sperling, Sarah A. Stahmer, Robert L. Stephen, Brian A. Stettler, Matthew Strehlow, Mark Su, Amita Sudhir, D. Matthew Sullivan, Jeffrey Tabas, Taku Taira, James K. Takayesu, Asim F. Tarabar, Danny G. Thomas, Kristine M. Thompson, Trevonne M. Thompson, Stephen Thornton, T. Paul Tran, Jacob Ufberg, Andrew S. Ulrich, Michael C. Wadman, Ernest E. Wang, N. Ewen Wang, Danielle M. Ware-McGee, Ian S. Wedmore, Natasha Wheaton, Beranton Whisenant, Max Wintermark, Michael E. Winters, Stephen J. Wolf, Richard E. Wolfe, Todd Wylie, Christine Yang-Kauh, Timothy P. Young, Steven M. Zahn, Cristina M. Zeretzke, David K. Zich, and Amy E. Zosel

Published
2013

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