Evidence-informed quality indicators for pediatric trauma care : An expert consensus study

Importance: Despite the unique physiological characteristics and healthcare 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. 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 non-pediatric trauma centers. Design, setting, and participants: We conducted a modified RAND/UCLA expert consensus study consisting of an on-line 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), five high-resource countries, and caregivers. Main Outcomes and Measures: Panelists rated 41 QIs on a 7-point Likert scale according to four criteria: importance, supporting evidence, actionability, and measurability. QIs with a global score ≥24/28 and an Importance score ≥6/7 were considered accepted by consensus. Results: We invited 65 experts of whom 59 accepted (91%), 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 (e.g. 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 (e.g. hypertonic saline in severe traumatic brain injury, stabilisation of femoral shaft fractures, nonoperative management of solid organ injuries), value in care (e.g. imaging in children at low risk on a clinical decision rule), patient-centered care (e.g. designated support person, caregiver presence), and equity (e.g. mental health screening). Conclusions: We propose 23 evidence-informed QIs that can be used by trauma quality improvement programs in high-resource countries to improve the effectiveness, safety, cost-effectiveness, equity and patient-centred nature of pediatric trauma care.