Variability in the structure and care processes for critically injured children: A multicenter survey of trauma bay and intensive care units

PurposeEvaluate national variation in structure and care processes for critically injured children.MethodsInstitutions with pediatric intensive care units (PICUs) that treat trauma patients were identified through the Virtual Pediatric Systems (n = 72). Prospective survey data were obtained from PICU and Trauma Directors (n = 69, 96% response). Inquiries related to structure and care processes in the PICU and emergency department included infrastructure, physician staffing, team composition, decision making, and protocol/checklist use.ResultsAbout one-third of the 69 institutions were ACS-verified Level-1 Pediatric Trauma Centers (32%); 36 (52%) were state-designated Level 1. The surgeon was the primary decision maker in the trauma bay at 88% of sites, and in the PICU at 44%. The intensivist was primary in the PICU at 30% of sites and intensivist consultation was elective at 11%. Free-standing pediatric centers used checklists more often than adult/pediatric centers for DVT prophylaxis (75% vs. 50%, p = 0.039), cervical spine clearance (75% vs. 44%, p = 0.011), and pain control (63% vs. 34%, p = 0.024). Otherwise, protocols/checklists were infrequently utilized by either center type.ConclusionVariability exists in structure and care processes for critically injured children. Further investigation of variation and its causal relationship to outcomes is warranted to provide optimal care.