Improving Outcomes in Pediatric Multi-System Trauma Care in Ontario Through Knowledge Implementation and Translation


BACKGROUND: Injuries are the leading cause of death and disability in children worldwide and in Canada. In Canada, 45% of children live more than an hour away from paediatric trauma centers. As a result, they are more likely to present to general emergency departments (ED) without paediatric expertise when injured. This is problematic because children have very different physiological responses to trauma and are managed differently than adult trauma patients. Recent studies have shown worse outcomes for these children living far from paediatric trauma centers, although the exact reasons for this remain unclear.

Literature suggests that human and physical resource scarcity, communication issues, complicated transfer processes and knowledge gaps may be contributing to this disparity in outcomes for paediatric trauma patients. In a recent needs assessment, general ED providers have highlighted paediatric multi-system trauma and head injuries as the most pressing clinical information gaps in paediatric emergencies. The combination of these two factors makes knowledge transfer an ideal target for interventions that could improve outcomes. Incidentally, there is currently a lack of existing knowledge transfer tools for paediatric multi-system trauma.

OBJECTIVE: This study aims to 1) understand the needs of general ED providers when managing paediatric multi-system trauma patients, 2) develop an implementation strategy for knowledge transfer tools specific to paediatric multi-system trauma.

METHODS: This project will consist of two phases. First, a needs assessment will be performed using a mixed methods approach combining a cross-sectional survey and focus groups targeting health care providers working at three different general EDs within the regional trauma network for the Greater Toronto Area. Results will be compiled into needs/gaps in paediatric trauma care at general EDs and barriers to improved care. In the second phase, one of the participating sites will be selected to co-create an implementation strategy using an iterative participatory research design involving focus groups and simulations at the selected site. Following this, we will use a consensus-based process to ensure that our final implementation strategy will be adapted to the specific needs of the site.

RESULTS: For the needs assessment, we will survey at least 120 providers across our three sites and to gain additional input from another 18-24 providers through our focus groups. Survey data will be analyzed in a descriptive manner, reporting counts and percentages for categorical variables and means and standard deviations for continuous variables. Focus group data will be evaluated inductively using standard coding techniques and deductively using the Consolidated Framework for Implementation Research. The output of the second phase of this project will be the creation of a detailed implementation strategy for KT tools in paediatric multi-system trauma.
CONCLUSIONS: This study will directly inform the implementation of KT tools which are under creation for paediatric multi-system trauma at this institution. We hope that, with some local adaptation, the implementation strategy can be scaled to other similar ED settings across the province and country. Clinically, the implementation of KT tools will increase provider knowledge, comfort, and efficacy when dealing with these cases and improve care and clinical outcomes for Canadian paediatric trauma patients. We also hope that the implementation strategy can be adapted to KT tools for other pediatric acute presentations.

Future research will measure the impact of our resources and dissemination and implementation strategy on health care practitioner practice and clinical outcomes for patients presenting to general EDs with multi-system trauma.

Capstone Team: 

Gabrielle Freire
Zi Li
Hui-Yu Lu
Naomi Zingman-Daniels


Capstone Advisory Committee:

Dr. Melanie Barwick
Dr Justin Losier
Dr. Shazeen Suleman


TRP Faculty Lead:

Dr. Richard Foty