Improving Pediatric Field Trauma Triage

项目总结 意外伤害是美国儿童死亡的主要原因。几项研究 当严重受伤的儿童被送到高级别(1级和2级)时，死亡率降低 和指定的儿科创伤中心，与低级别(3级或更高)和非创伤相比 中锋。现场创伤分诊旨在确定需要高级别创伤中心资源的患者，95% 美国外科医师学会创伤委员会设定的敏感性和65%特异性目标 (ACSCOT)。ACSCOT和疾病控制和预防中心(CDC)公布现场分诊 全国急救医疗服务(EMS)机构广泛使用的标准。这些标准是 通过专家共识开发和更新，主要针对成年人，并已被证明是分流不足 严重受伤的儿童，据报道敏感度低至65%。在2020年的系统评估中，儿科 创伤学会研究委员会表示，支持现场分诊标准的数据是“最低和最低的 特别呼吁进行新的研究，以建立单独的标准和标准的组合，以 确定受伤的儿童应该被运送到哪里。虽然需要完善的儿科现场分诊标准 很明显，进展受到缺乏大规模、相关的院前和结局数据的限制 实施失败，包括缺少和不准确的生理测量(例如，血压和 精神状态)，以及过度依赖提供者的判断作为创伤中心需求的唯一决定因素。至 解决这些差距并改善受伤儿童的院前分诊，我们将进行描述性 使用AHRQ医疗成本和利用率(HCUP)数据库对7个州的儿童营养不良进行分析， 使用稳健的基于人口的数据集的预测建模来导出和验证精细化的儿科现场分诊 包含来自洛杉矶县的院前和结果数据，并进行混合方法研究 评估细化标准在城市EMS系统中的实施效果。这项建议直接 针对AHRQ的优先人群，包括儿科、少数民族、农村和低收入人群，并直接 响应AHRQ通过识别潜在危害来改善医疗患者安全的研究优先事项 在营养不足、设计和评估干预措施以改善患者安全方面的差异，以及 利用数据(包括HCUP数据库)来改善卫生保健质量和患者结果。成功 这项工作的完成将通过描述精确场对健康的潜在影响来推进这一领域的研究 分类，建立初步实施成果，为大规模混合有效性做准备- 实施试验，以评估细化的标准，并确定伤员院前护理的关键障碍 让儿童了解未来的适应和实施战略。在这个奖项期间，我将获得培训， 在大规模数据分析、预测建模和研发科学方面的指导和经验 成为一名独立的卫生服务研究员，专注于改善儿童的紧急护理。

PROJECT SUMMARY Unintentional injury is the leading cause of death among children in the United States. Several studies demonstrate decreased mortality when severely injured children are transported to high-level (levels 1 and 2) and designated pediatric trauma centers, compared with low-level (levels 3 or greater) and non-trauma centers. Field trauma triage aims to identify patients who require high-level trauma center resources, with 95% sensitivity and 65% specificity goals set by the American College of Surgeons Committee on Trauma (ACSCOT). The ACSCOT and the Centers for Disease Control and Prevention (CDC) publish field triage criteria, which are widely used by emergency medical service (EMS) agencies nationally. These criteria were developed and updated through expert consensus primarily for adults, and have been shown to undertriage severely injured children, with a reported sensitivity as low as 65%. In a 2020 systematic review, the Pediatric Trauma Society Research Committee stated the data supporting field triage criteria are “minimal and of low quality,” specifically calling for new research to establish individual criteria and combinations of criteria to determine where an injured child should be transported. While the need for refined pediatric field triage criteria is clear, progress has been limited by the lack of large-scale, linked prehospital and outcome data and implementation failures including missing and inaccurate physiologic measurements (e.g. blood pressure and mental status), and overreliance on provider judgement as the sole determinant of trauma center need. To address these gaps and improve the prehospital triage of injured children, we will perform a descriptive analysis of undertriage of children in 7 states using AHRQ Healthcare Cost and Utilization (HCUP) databases, derive and validate refined pediatric field triage using predictive modeling of a robust population-based dataset containing prehospital and outcome data from Los Angeles County, and conduct a mixed-methods study evaluating implementation outcomes of the refined criteria in an urban EMS system. This proposal directly addresses AHRQ priority populations including pediatric, minority, rural, and low-income, and is directly responsive to AHRQ research priorities of improving health care patient safety by identifying potential harm from and disparities in undertriage, designing and evaluating interventions to improve patient safety, and harnessing data (including HCUP databases) to improve health care quality and patient outcomes. Successful completion of this work will advance this field of study by describing the potential health impact of accurate field triage, establishing preliminary implementation outcomes in preparation for a large, hybrid effectiveness- implementation trial to evaluate the refined criteria, and identifying key barriers to prehospital care of injured children to inform future adaptations and implementation strategies. During this award, I will obtain the training, mentorship, and experience in large-scale data analytics, predictive modeling, and D&I science necessary to become an independent health services researcher focused on improving emergency care for children.