Improving outcomes in pediatric multi-system trauma care in ontario through knowledge implementation and translation
This study assesses pediatric trauma management in general emergency departments across Canada, identifying key sources of practice variation and highlighting knowledge translation (KT) as a promising strategy for improving care.
Background
Traumatic injuries are the leading cause of death and disability in children both in Canada and worldwide, and are associated with high direct and indirect costs to our health care system. In children, falls and motor vehicle collisions are the two main mechanisms of injury responsible for morbidity and mortality. This type of trauma tends to injure multiple systems at once (multisystem trauma) in children given their small size, pliable musculoskeletal system, and less protected internal organs. In Canada, health care providers (HCPs) face a challenge in delivering optimal trauma care because of population dispersion over large distances. This is particularly true for paediatric trauma patients, as there are fewer trauma centers treating children, i.e. paediatric trauma centres (PTC). Canadian data show that at least 45% of children live more than one hour away from a PTC and that 88% of injuries happen within a 10-mile radius of home. This means that most pediatric patients have no easy access to PTCs when injured.
The TREKK (Translating Emergency Knowledge for Kids) network highlighted that the most pressing clinical information needs among HCPs managing paediatric patients in EDs without paediatric expertise (hereon referred to as general EDs) pertained to paediatric multi-system trauma and severe head injuries. Although data do not yet exist detailing practice variations in paediatric trauma at the resuscitation level, some studies have demonstrated significant practice variation in the acute management of paediatric trauma patients between paediatric and adult trauma centers. Canadian data also suggest that general EDs have lower adherence to guidelines compared to pediatric EDs when managing different simulated paediatric resuscitations due to a lower rate of paediatric exposure.
The combination of these findings suggests that practice variation is an important factor in suboptimal delivery of care. As such, our team set out to perform a more detailed needs assessment on paediatric trauma management at general EDs. We identified five potential sources of practice variation and selected KT as the opportunity with the most potential for rapid and significant impact on practice variation.
Project team
- Gabrielle Freire
- Zi Teng Li
- Hui-Yu Lu
- Naomi Zingman-Daniels
TRP supervisors
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