Quality assessment in initial paediatric trauma care: Systematic review from prehospital care to the paediatric intensive care unit

Abstract

BackgroundTrauma is the most common cause of death and disability in the paediatric population. There are a huge number of variables involved in the care they receive from health care professionals.AimThe aim of this study was to review the available evidence of initial paediatric trauma care throughout the health care process with a view to create quality indicators (QIs).Study DesignA systematic review was performed from Cochrane Library, Medline, Scopus and SciELO between 2010 and 2020. Studies and guidelines that examined quality or suggested QI were included. Indicators were classified by health care setting, Donabedian's model, risk of bias and the quality of the publication with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment.ResultsThe initial search included 686 articles, which were reduced to 22, with 15 primary and 7 secondary research articles. The snowball sampling technique was used to add a further seven guidelines and two articles. From these, 534 possible indicators were extracted, summarizing them into 39 and grouping the prehospital care indicators as structure (N = 5), process (N = 12) and outcome (N = 3) indicators and the hospital care indicators as structure (N = 4), process (N = 10) and outcome (N = 6) indicators. Most of the QIs have been extracted from US studies. They are multidisciplinary and in some cases are based on an adaptation of the QIs of adult trauma care.ConclusionsThere was a clear gap and large variability between the indicators, as well as low‐quality evidence. Future studies will validate indicators using the Delphi method.Relevance to Clinical PracticeDesign a QI framework that may be used by the health system throughout the process. Indicators framework will get nurses, to assess the quality of health care, detect deficient areas and implement improvement measures.

Celebrating our success over the holiday period: 40 papers to read over the holiday

“…An Iranian study 20 In this issue, we also include three systematic reviews: one aimed at identifying a population of critically ill children who have the highest risk of developing venous thromboembolism, 32 one examined the effectiveness of music listening on sleep quality, psychological outcomes, and physiological outcomes of critically ill patients, 33 and one reviewed the available evidence of initial paediatric trauma care throughout the health care process. 34 We also include a brief report 35 that describes the development, structure, and implementation of an evidence-based protocol for sensory soothing interventions in critically ill infants and children in the United States, and a protocol of a mixed-methods, multicentre study aimed at developing and testing an e-health intervention in a follow-up service to support ICU patients' relatives. 36 Furthermore, a case study of a pregnant woman who was diagnosed with acute fatty liver of pregnancy in China is presented.…”