Measuring the impact of a “Virtual Pediatric Trauma Center” (VPTC) model of care using telemedicine for acutely injured children versus the standard of care: study protocol for a prospective stepped-wedge trial

Trials

Study Protocol

Kendra L. Grether-Jones¹  Marike Zwienenberg²  Holly B. Leshikar³  Brian M. Haus³  Daniel J. Tancredi⁴  Jennifer L. Rosenthal⁴  James P. Marcin⁴  Michelle Y. Hamline⁴  Nathan Kuppermann⁵  Jeffrey S. Hoch⁶  Joseph M. Galante⁷  Tanya N. Rinderknecht⁷ 

[1] Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA;Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA;Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA, USA;Department of Pediatrics, University of California, Davis, Sacramento, CA, USA;Department of Pediatrics, University of California, Davis, Sacramento, CA, USA;Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA;Department of Public Health Sciences, University of California, Davis, Sacramento, CA, USA;Department of Surgery, University of California, Davis, Sacramento, CA, USA;

关键词: Pediatric;    Trauma;    Telemedicine;    Telehealth;    Family distress;    Emergency department;    Randomized controlled trial;   

DOI  :  10.1186/s13063-022-06996-1

 received in 2022-10-08, accepted in 2022-12-08,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe current standard of care in the treatment of children with physical trauma presenting to non-designated pediatric trauma centers is consultation with a pediatric trauma center by telephone. This includes contacting a pediatric trauma specialist and transferring any child with a potentially serious injury to a regionalized level I pediatric trauma center. This approach to care frequently results in medically unnecessary transfers and may place undue burdens on families. A newer model of care, the “Virtual Pediatric Trauma Center” (VPTC), uses telemedicine to make the expertise of a level I pediatric trauma center virtually available to any hospital. While the use of the VPTC model of care is increasing, there have been no studies comparing the VPTC to standard care of injured children at non-designated trauma centers with respect to patient- and family-centered outcomes. The goal of this study is to compare the current standard of care to the VPTC with respect to family-centered outcomes developed by parents and community advisory boards.MethodsWe will use a stepped-wedge trial design to enroll children with physical trauma presenting to ten hospitals, including level II, level III, and non-designated trauma centers. The primary outcome measures are parent/family experience of care and distress 3 days following injury. Secondary aims include 30-day healthcare utilization, parent/family out-of-pocket costs at 3 days and 30 days after injury, transfer rates, and parent/family distress 30 days following injury. We expect at least 380 parents/families of children will be eligible for the study following an emergency department physician’s request for a level I pediatric trauma center consultation. We will evaluate parent/family experience of care and distress using previously validated instruments, healthcare utilization by family recollection and medical record abstraction, and out-of-pocket costs using standard economic analyses.DiscussionWe expect that the findings from this study will inform other level I pediatric trauma centers and non-pediatric trauma centers on how to improve their systems of care for injured children. The results will help to optimize communication, confidence, and shared decision-making between parents/families and clinical staff from both the transferring and receiving hospitals.Trial registrationClinicalTrials.gov Identifier: NCT04469036. Registered July 13, 2020 before start of inclusion.

【 授权许可】

CC BY   
© The Author(s) 2022