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OBJECTIVES: To assess pediatric critical care transport (CCT) teams' performance in a simulated environment and to explore the impact of team and center characteristics on performance. STUDY DESIGN: This observational, multi-center, simulation-based study enlisted a national cohort of pediatric transport centers. Teams participated in three scenarios: non-accidental abusive head injury (NAT), sepsis, and cardiac arrest. The primary outcome was teams' simulation performance score. Secondary outcomes were associations between performance, center and team characteristics. RESULTS: We recruited 78 transport teams with 196 members from 12 CCT centers. Scores on performance measures that were developed were 89% (IQR 78-100) for NAT, 63.3% (IQR 45.5-81.8) for sepsis, and 86.6% (IQR 66.6-93.3) for cardiac arrest. In multivariable analysis, overall performance was higher for teams including a respiratory therapist (RT; (0.5 points [95% CI: 0.13, 0.86]) or paramedic (0.49 points [95% CI: 0.1, 0.88]) and dedicated pediatric teams (0.37 points [95% 0.06, 0.68]). Each year increase in program age was associated with an increase of 0.04 points (95% CI: 0.02, 0.06). CONCLUSIONS: Dedicated pediatric teams, inclusion of RTs and paramedics, and center age were associated with higher simulation scores for pediatric CCT teams. These insights can guide efforts to enhance the quality of care for children during interfacility transports.
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Dolor Abdominal , Cefalea , Masculino , Humanos , Niño , Cefalea/etiología , Dolor Abdominal/etiología , Fatiga/etiologíaAsunto(s)
Pancitopenia , Masculino , Humanos , Lactante , Pancitopenia/etiología , Fiebre/etiología , TransaminasasRESUMEN
BACKGROUND: Two-generational trauma-informed assessment (TIA) helps providers conduct holistic family well-being assessment (FWbA). This tool makes it possible to use families' trauma history in the case-finding process. OBJECTIVE: This study compares the documentation and frequency of adverse childhood experiences (ACEs) and service referral rates for index children and their caretakers in two groups of families evaluated in a child abuse clinic (CAC). PARTICIPANTS AND SETTING: The sample consisted of 364 children stratified into two groups: Group 1 - children seen in the CAC after implementation of FWbA in years 2014, 2015, 2016 and Group 2 - children seen in the CAC prior to implementation of FWbA in years 2011, 2012, 2013. METHODS: Researchers utilized retrospective chart review method and analyzed data regarding ACEs and service referrals for patients and their caregivers. RESULTS: Documentation of ACEs was higher in Group 1 for children (77.7 % vs 26.6 %,pâ¯<⯠0.0001) and caretakers (60.7 % vs 7.3 % pâ¯<⯠0.0001). Caretakers in Group 1 had a higher rate of four or more ACEs (47.0 % vs 5.1 % pâ¯<⯠0.001) while the increase for children was not statistically significant (61.4 % vs 51.1 %, pâ¯=⯠0.110). Both children and caretakers were referred to more services in Group 1 (2.7 + 1.5 vs 1.5 + 1.3, and 3.0 + 1.9 vs 1.2 + 1.2, respectively, pâ¯<⯠0.0001). CONCLUSIONS: In families evaluated for child abuse and neglect, conducting TIA in addition to conventional psychosocial evaluation increased documentation regarding trauma history, which led to increased referral rates.