TY - JOUR
T1 - Pediatric Trauma Care Standardization
T2 - A Statewide Survey of Trauma Providers and Program Managers
AU - Stephens, Caroline Q.
AU - Ashok, Arjun
AU - Gee, Arvin
AU - Jafri, Mubeen
AU - Hamilton, Nicholas A.
AU - Lehrfeld, David
AU - Newgard, Craig
AU - Krishnaswami, Sanjay
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/8
Y1 - 2023/8
N2 - Introduction: Rural–urban disparities in pediatric trauma outcomes are well documented. However, few studies examine how differences in setting and resources impact rural providers’ approach to trauma. We sought to understand the provider experience in managing injured children across our state and assess the potential for standardization of care. Methods: A statewide cross-sectional survey was distributed to trauma providers and program managers through the American College of Surgeons, the Oregon Medical Board lists, and the State Trauma Advisory Board. Topics included pediatric management processes, challenges, and transfer or admission procedures. Rural–urban commuting codes were used to categorize responses. Results: Of the 350 individuals who sent the survey, 68 responded (response rate 19%), representing 67% of trauma-verified hospitals and 72% of Oregon counties. Fifty-six respondents (82%) care for injured children, with 58% practicing rurally and 22% at critical access hospitals. Rural providers experienced lower trauma volumes (<1 patient/month, 63% versus 0%, P < 0.001), more difficulties obtaining pediatric-appropriate material resources (44% versus 30%), and challenges caring for infants/toddlers (25% versus 17%). Despite 77% of rural providers stating that <10% of patients had multisystem injuries, they described using full-body CT often (41% versus 10%, P = 0.007). Transfer interruptions were common (93%), with 44% having cancelled a transfer. The majority supported admission/transfer (85%) and imaging (82%) protocols. Conclusions: Rural providers experience lower pediatric trauma volumes, greater material-resource issues, and discomfort with traumatically injured small children. Lack of care standardization may lead to reliance on full-body CT, and potentially complex/avoidable transfers. Adoption of standardized protocols could facilitate a state-wide collaborative approach to pediatric trauma management.
AB - Introduction: Rural–urban disparities in pediatric trauma outcomes are well documented. However, few studies examine how differences in setting and resources impact rural providers’ approach to trauma. We sought to understand the provider experience in managing injured children across our state and assess the potential for standardization of care. Methods: A statewide cross-sectional survey was distributed to trauma providers and program managers through the American College of Surgeons, the Oregon Medical Board lists, and the State Trauma Advisory Board. Topics included pediatric management processes, challenges, and transfer or admission procedures. Rural–urban commuting codes were used to categorize responses. Results: Of the 350 individuals who sent the survey, 68 responded (response rate 19%), representing 67% of trauma-verified hospitals and 72% of Oregon counties. Fifty-six respondents (82%) care for injured children, with 58% practicing rurally and 22% at critical access hospitals. Rural providers experienced lower trauma volumes (<1 patient/month, 63% versus 0%, P < 0.001), more difficulties obtaining pediatric-appropriate material resources (44% versus 30%), and challenges caring for infants/toddlers (25% versus 17%). Despite 77% of rural providers stating that <10% of patients had multisystem injuries, they described using full-body CT often (41% versus 10%, P = 0.007). Transfer interruptions were common (93%), with 44% having cancelled a transfer. The majority supported admission/transfer (85%) and imaging (82%) protocols. Conclusions: Rural providers experience lower pediatric trauma volumes, greater material-resource issues, and discomfort with traumatically injured small children. Lack of care standardization may lead to reliance on full-body CT, and potentially complex/avoidable transfers. Adoption of standardized protocols could facilitate a state-wide collaborative approach to pediatric trauma management.
KW - Access
KW - Disparities
KW - Pediatric trauma
KW - Rural
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U2 - 10.1016/j.jss.2023.02.013
DO - 10.1016/j.jss.2023.02.013
M3 - Article
C2 - 36989834
AN - SCOPUS:85151483144
SN - 0022-4804
VL - 288
SP - 178
EP - 187
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -