Consensus‐based Criterion Standard for the Identification of Pediatric Patients Who Need Emergency Medical Services Transport to a Hospital with Higher‐level Pediatric Resources

Studnek, Jonathan R.; Lerner, E. Brooke; Shah, Manish I.; Browne, Lorin R.; Brousseau, David C.; Cushman, Jeremy T.; Dayan, Peter; Drayna, Patrick C.; Drendel, Amy L.; Gray, Matthew P.; Kahn, Christopher A.; Meyer, Michael T.; Shah, Manish N.; Stanley, Rachel

doi:10.1111/acem.13625

Cited by 11 publications

(8 citation statements)

References 14 publications

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“…A recently published consensus‐based criteria to identify children encountered by EMS who should be transferred to higher‐level pediatric facilities, for example, noted abnormal vital signs in a medically complex child as a reason for this higher level of care. 20 Another Delphi‐based approach toward the development of a destination tool specifically noted challenges with currently used vital sign specifications for this purpose. 16 These examples demonstrate a potential role toward empirically derived vital signs to achieve these aims without increasing resource utilization.…”

Section: Discussionmentioning

confidence: 99%

“…Ideally, specific cutoffs would be generated through multidisciplinary stakeholder input to identify optimal tradeoffs to derive a model with greatest utility. A recently published consensus‐based criteria to identify children encountered by EMS who should be transferred to higher‐level pediatric facilities, for example, noted abnormal vital signs in a medically complex child as a reason for this higher level of care 20 16 .…”

Section: Discussionmentioning

confidence: 99%

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Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency setting

Ramgopal

Sepanski

Crowe³

et al. 2023

JACEP Open

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Objective To compare Pediatric Advanced Life Support (PALS) diastolic blood pressure (DBP) criteria to empirically derived DBP criteria for the prediction of out‐of‐hospital interventions in children. Methods We performed a retrospective study of pediatric (<18 years) encounters from the ESO Data Collaborative, which includes approximately 2000 Emergency Medical Services agencies in the United States. We developed age‐based centile curves for DBP using generalized additive models for location, scale, and shape. We compared the proportion of encounters with a low DBP when using empirically derived and PALS criteria and calculated their associations with the delivery of out‐of‐hospital interventions (advanced airway management, cardiopulmonary resuscitation, cardiac epinephrine, any systemic epinephrine, defibrillation, and bolus intravenous fluids). Results We included 343,129 encounters. When using PALS criteria, 155,564 (45.3%) were classified as having abnormal DBP, including 120,624 (35.2%) with high DBP and 34,940 (10.2%) with low DBP. When using empirically‐derived criteria, 18.6% had an abnormal DBP (ie, a DBP <10th or >90th centile). The accuracy of low DBP for out‐of‐hospital interventions between the two criteria was similar. Conclusion PALS criteria for DBP classified a high proportion of children as having abnormal vital signs, particularly with diastolic hypertension. Empirically derived DBP thresholds more accurately predict the delivery of key out‐of‐hospital interventions. If externally validated, correlated to in‐hospital outcomes, and combined with thresholds for other vital signs, these may better predict the need for out‐of‐hospital interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency setting

Ramgopal

Sepanski

Crowe³

et al. 2023

JACEP Open

View full text Add to dashboard Cite

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“…Many only allow providers to override a parent's destination facility request in the case of suspicion of severe trauma, cardiac arrest, or an inability to manage the patient's airway. However, it is the consensus of many experts that there is a much broader set of conditions in children where higher‐level pediatric resources are likely to be needed . Whether these conditions warrant overriding parent choice could be debated, but providers should at least be able to make recommendations to families so that they can make an informed destination decision.…”

Section: Discussionmentioning

confidence: 99%

Multicenter Analysis of Transport Destinations for Pediatric Prehospital Patients

Lerner

Studnek²,

Fumo

et al. 2018

Academic Emergency Medicine

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Background: Although all emergency departments (EDs) should be ready to treat children, some may have illnesses or injuries that require higher-level pediatric resources that are not available at all hospitals. There are no national guidelines for emergency medical services (EMS) providers about when to directly transport children to hospitals with higher-level pediatric resources, with the exception of severe trauma. Variability exists in EMS protocols about when children warrant transport to hospitals with higher-level pediatric care.Objective: The objective was to determine how frequently pediatric patients are transported by EMS to hospitals with higher-level pediatric resources and to evaluate distribution patterns based on illness and injury severity. Methods:We conducted a retrospective analysis of all pediatric (age 0-18 years) transports in three large EMS systems between November 2014 and November 2016. Each community had a hospital with higher-level pediatric resources that was within a 30-minute transport time from any location. Patients were included if they were transported by ground ambulance and the request originated in the 9-1-1 system. We assessed the frequency of transports to a hospital with higher-level pediatric resources. Data were stratified by chief complaint of illness or injury and severity. Potential risk for severe injury was defined as meeting the physiologic step of the field triage guidelines and potential risk for severe illness was defined as having an abnormal vital sign after adjusting for patient age.Results: A total of 41,345 pediatric patients were transported by a participating EMS agency to an ED and had complete destination data. A total of 55% of all EMS-transported pediatric patients were transported to a hospital with higher-level pediatric resources. There was variation by site (range = 45%-71%) in the percentage of children who went to a hospital with higher-level pediatric resources. Patients over 15 years of age went to general EDs (57%) more often than younger patients. When stratified by severity, 60% of those with potentially severe illness and 74% of those with potentially severe trauma were transported to a hospital with higher-level pediatric resources.Conclusions: EMS providers commonly transport children to hospitals with higher-level pediatric resources.However, more than one-quarter of children with potentially severe injuries and illnesses are transported to general EDs.

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“…The modified Delphi method guides a multidisciplinary group of subject matter experts to arrive at a consensus [27]. That methodology has previously been applied to healthcare settings, including for EMS decision tools [28][29][30][31]. In the modified Delphi technique, the research team presents questions or scenario-based cues to an expert panel (EP), and EP members vote on each question/cue independently [27].…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2021

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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.

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Consensus‐based Criterion Standard for the Identification of Pediatric Patients Who Need Emergency Medical Services Transport to a Hospital with Higher‐level Pediatric Resources

Cited by 11 publications

References 14 publications

Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency setting

Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency setting

Multicenter Analysis of Transport Destinations for Pediatric Prehospital Patients

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

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