Lynne Moore, Natalie L Yanchar, Pier-Alexandre Tardif, Matthew Weiss, Emilie Beaulieu, Antonia Stang, Isabelle Gagnon, Belinda Gabbe, Thomas Stelfox, Ian Pike, Alison Macpherson, Simon Berthelot, Terry Klassen, Suzanne Beno, Sasha Carsen, Mélanie Labrosse, Roger Zemek, Fran Priestap, Brett Burstein, Katherine E Remick, Keith Owen Yeates, Neil Merritt, Nathan Kuppermann, Ruth Loellgen, Naomi Davis, Fiona Lecky, Warwick Teague, Andrew Holland, Christian Malo, Marianne Beaudin, Patrick Archambault, Gabrielle Freire
{"title":"儿童创伤护理的循证质量指标。","authors":"Lynne Moore, Natalie L Yanchar, Pier-Alexandre Tardif, Matthew Weiss, Emilie Beaulieu, Antonia Stang, Isabelle Gagnon, Belinda Gabbe, Thomas Stelfox, Ian Pike, Alison Macpherson, Simon Berthelot, Terry Klassen, Suzanne Beno, Sasha Carsen, Mélanie Labrosse, Roger Zemek, Fran Priestap, Brett Burstein, Katherine E Remick, Keith Owen Yeates, Neil Merritt, Nathan Kuppermann, Ruth Loellgen, Naomi Davis, Fiona Lecky, Warwick Teague, Andrew Holland, Christian Malo, Marianne Beaudin, Patrick Archambault, Gabrielle Freire","doi":"10.1001/jamapediatrics.2025.0036","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Design, setting, and participants: </strong>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.</p><p><strong>Exposure: </strong>Likert-scale ratings of 41 QIs.</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959479/pdf/","citationCount":"0","resultStr":"{\"title\":\"Evidence-Informed Quality Indicators for Pediatric Trauma Care.\",\"authors\":\"Lynne Moore, Natalie L Yanchar, Pier-Alexandre Tardif, Matthew Weiss, Emilie Beaulieu, Antonia Stang, Isabelle Gagnon, Belinda Gabbe, Thomas Stelfox, Ian Pike, Alison Macpherson, Simon Berthelot, Terry Klassen, Suzanne Beno, Sasha Carsen, Mélanie Labrosse, Roger Zemek, Fran Priestap, Brett Burstein, Katherine E Remick, Keith Owen Yeates, Neil Merritt, Nathan Kuppermann, Ruth Loellgen, Naomi Davis, Fiona Lecky, Warwick Teague, Andrew Holland, Christian Malo, Marianne Beaudin, Patrick Archambault, Gabrielle Freire\",\"doi\":\"10.1001/jamapediatrics.2025.0036\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Design, setting, and participants: </strong>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.</p><p><strong>Exposure: </strong>Likert-scale ratings of 41 QIs.</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":14683,\"journal\":{\"name\":\"JAMA Pediatrics\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":24.7000,\"publicationDate\":\"2025-03-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959479/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAMA Pediatrics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1001/jamapediatrics.2025.0036\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamapediatrics.2025.0036","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Evidence-Informed Quality Indicators for Pediatric Trauma Care.
Importance: 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.
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 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.
Exposure: Likert-scale ratings of 41 QIs.
Main outcomes and measures: 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.
Results: 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).
Conclusions: 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.
期刊介绍：
JAMA Pediatrics, the oldest continuously published pediatric journal in the US since 1911, is an international peer-reviewed publication and a part of the JAMA Network. Published weekly online and in 12 issues annually, it garners over 8.4 million article views and downloads yearly. All research articles become freely accessible online after 12 months without any author fees, and through the WHO's HINARI program, the online version is accessible to institutions in developing countries.
With a focus on advancing the health of infants, children, and adolescents, JAMA Pediatrics serves as a platform for discussing crucial issues and policies in child and adolescent health care. Leveraging the latest technology, it ensures timely access to information for its readers worldwide.
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