O'Connell Karen J, Farah Mirna M, Spandorfer Philip, Zorc Joseph J
Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Pediatrics. 2007 Sep;120(3):e565-74. doi: 10.1542/peds.2006-2914.
When a child presents to a trauma center with a serious injury, family members are often excluded from the initial trauma team evaluation. The objective of this study was to evaluate the outcomes of a structured program of family presence during pediatric trauma team activations by measuring (1) the need for termination of family presence, (2) times to completion of key parts of the trauma evaluation, and (3) the opinions of staff surveyed immediately after conclusion of family presence.
This was a cross-sectional study that combined prospectively obtained data and surveys from trauma team evaluations in which family presence occurred, with retrospective chart review of all trauma activations during an 18-month study period. The study was conducted at a level 1 pediatric trauma center with a preestablished family presence program that assigns a staff member to screen family members for family presence, provide support, and record events. Times to completion of key components of the trauma evaluation were calculated and compared for cases with and without family presence. Cross-sectional surveys were performed immediately after each trauma team evaluation.
A total of 197 family members participated in family presence. There were no cases of interference with medical care by family members. Seven family members were asked to leave the trauma area by staff after initiation of family presence for various reasons. Times to completion of key components of the trauma evaluation did not differ significantly between enrolled patients with family presence and those without family presence. Surveys were completed for 136 cases, and the majority of providers reported that family presence either had no effect on or improved medical decision-making (97%), institution of patient care (94%), communication among providers (92%), and communication with family members (98%).
This prospective study suggests that there is an overall low prevalence of negative outcomes associated with family presence during pediatric trauma team evaluation after implementation of a structured family presence program. Excluding family members as a routine because of provider concerns about negative impact on clinical care does not seem to be indicated.
当儿童因重伤被送往创伤中心时，家庭成员通常会被排除在初始创伤团队评估之外。本研究的目的是通过测量以下内容来评估在儿科创伤团队启动期间实施结构化家属在场计划的结果：（1）终止家属在场的必要性；（2）完成创伤评估关键部分的时间；（3）家属在场结束后立即接受调查的工作人员的意见。
这是一项横断面研究，将前瞻性获得的数据和对有家属在场的创伤团队评估的调查结果，与对18个月研究期间所有创伤启动情况的回顾性病历审查相结合。该研究在一家一级儿科创伤中心进行，该中心有一个预先制定的家属在场计划，安排一名工作人员对家属进行在场筛查、提供支持并记录事件。计算并比较了有和没有家属在场的病例完成创伤评估关键组成部分的时间。在每次创伤团队评估后立即进行横断面调查。
共有197名家庭成员参与了家属在场。没有家属干扰医疗护理的情况。7名家庭成员在家属在场开始后，因各种原因被工作人员要求离开创伤区域。有家属在场的登记患者和没有家属在场的患者在完成创伤评估关键组成部分的时间上没有显著差异。完成了136例调查，大多数提供者报告说家属在场对医疗决策（97%）、患者护理的实施（94%）、提供者之间的沟通（92%）以及与家庭成员的沟通（98%）要么没有影响，要么有改善。
这项前瞻性研究表明，在实施结构化家属在场计划后，儿科创伤团队评估期间与家属在场相关的负面结果总体发生率较低。由于提供者担心对临床护理产生负面影响而将家属作为常规排除在外似乎没有必要。
