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
Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus), Québec, Québec, Canada.
Department of Social and Preventative Medicine, Université Laval, Québec, Québec, Canada.
JAMA Pediatr. 2025 Mar 31. doi: 10.1001/jamapediatrics.2025.0036.
Despite the unique physiological characteristics and health care needs of pediatric trauma patients, there is a lack of quality indicators (QIs) based on pediatric-specific evidence to support quality improvement in this population.
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.
Likert-scale ratings of 41 QIs.
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.
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).
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.
尽管儿科创伤患者具有独特的生理特征和医疗保健需求，但缺乏基于儿科特定证据的质量指标（QIs）来支持该人群的质量改进。
制定一套基于共识的急性儿科创伤护理质量指标，该指标考虑有效性、安全性、成本效益、公平性和护理人员观点等方面的证据，并且适用于儿科和非儿科创伤中心。
设计、背景和参与者：开展了一项经过改进的研发（RAND）/加利福尼亚大学洛杉矶分校（UCLA）专家共识研究，包括在线调查和虚拟研讨会，由一名独立主持人牵头。小组成员代表儿科创伤患者管理的关键领域、不同的护理环境（从一级儿科创伤中心到三级转诊中心）、5个资源丰富的国家以及护理人员。于2024年5月至8月对数据进行了分析。
对41项质量指标进行李克特量表评分。
小组成员根据重要性、支持证据、可操作性和可测量性这4项标准，对41项质量指标进行7分制李克特量表评分。全球得分达到28分中的24分或更高且重要性得分达到7分中的6分或更高的质量指标被视为经共识认可。
共邀请了65名专家，其中59名接受邀请（91%；25名年龄超过50岁[44.7%]；34名女性[60.7%]），56名（95%）完成了第一轮，54名（92%）完成了两轮。选定了23项质量指标，涵盖急性儿科创伤管理的关键领域（例如，因神经创伤或严重多系统创伤转至儿科创伤中心、生命体征记录、早期康复、营养支持）、最常见的损伤类型（例如，重度创伤性脑损伤中使用高渗盐水、股骨干骨折的固定、实体器官损伤的非手术治疗）、护理价值（例如，根据临床决策规则对低风险儿童进行影像学检查）、以患者为中心的护理（例如，指定支持人员、护理人员在场）以及公平性（例如，心理健康筛查）。
资源丰富国家的创伤质量改进项目可利用这些结果来选择针对具体情况的质量指标, 以提高儿科创伤护理的有效性、安全性、成本效益、公平性以及以患者为中心的程度。
