Priorities for Research in Emergency Medical Services for Children: Results of a Consensus Conference

doi:10.1016/S0196-0644(99)70395-1

Annals of Emergency Medicine

Volume 33, Issue 2, February 1999, Pages 206-210

https://doi.org/10.1016/S0196-0644(99)70395-1 Get rights and content

Abstract

Study objective: To arrive at a consensus on the priorities for future research in emergency medical services for children. Methods: A consensus group was convened using the Rand-UCLA Consensus Process. The group took part in a 3-phase process. Round 1 involved reviewing a compendium of relevant research articles and answering a mailed questionnaire. Panel members were asked to prioritize topics on the basis of the 1993 Institute of Medicine Report on Emergency Medical Services for Children. Participants were asked to rate each topic based on the significance of the research, and whether the topic would (1) improve general knowledge, (2) change behavior, (3) improve health, (4) decrease the cost of care, or (5) change public policy. A 4-point Likert scale was used. Participants were also asked if the research would require a multicenter study and if the research were feasible. Round 2 of the study involved a meeting of the panel, where the results of Round 1 were discussed and the topics were reprioritized. The topics were given a rank order and a final ranking was done in Round 3. Results: The panel considered a list of 32 topics; these were combined and reworded to give them more precise meaning. Several new topics were also added. Fifteen topics were given a rank order and placed within the 7 broad categories of the Institute of Medicine report. Clinical aspects of emergency care, systems organization, configuration, and operation and injury prevention were given high priority rankings. The first 5 topics were very close in point-rank order. Conclusion: The panel was able to develop a list of important topics for future research in emergency medical services for children that can be used by foundations, governmental agencies, and others in setting a research agenda for such services.

[Seidel JS, Henderson D, Tittle S, Jaffe DM, Spaite D, Dean JM, Gausche M, Lewis RJ, Cooper A, Zaritsky A, Espisito T, Maederis D: Priorities for research in emergency medical services for children: Results of a consensus conference. Ann Emerg Med February 1999;33:206-210.]

Section snippets

INTRODUCTION

Improving the care of ill and injured pediatric patients has been a major goal of the Emergency Medical Services for Children (EMSC) Program since its inception. This program has now been funded for 12 years, administered by the US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau in collaboration with the Department of Transportation, National Highway Traffic Safety Administration. Almost every state has received EMSC

MATERIALS AND METHODS

The Rand-UCLA consensus process was used to ensure validity of the results of this consensus conference.8, 9 To develop the list of invitees for the conference, a letter was sent to all present and former EMSC grantees, all state EMS directors, and selected pediatric emergency medicine program directors asking them to identify persons who they considered experts in research in emergency medical services for children. The 10 persons receiving the most votes were invited to participate in the

RESULTS

From the initial 32 topics considered by the panel in Round 1, the topics were combined and reworded for more precise meaning; several new topics were also added. A final list of 15 topics was developed and prioritized by the participants in rank order. The final consensus results of research topics in priority order are listed in Figure 2

Research topics

1.
Management of major clinical entities such as:

•
Shock
•
Respiratory distress
•
Asthma
•
Brain injury
•
Multiple organ trauma
•
Seizures
•
Poisoning
•
Behavioral disorders
•
Burns
•
Fever
•

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Cited by (53)

Improving Prehospital Management of Children With Respiratory Distress
2018, Clinical Pediatric Emergency Medicine
For prehospital providers, guidelines for managing children with respiratory distress are often based on expert opinion, extrapolated from studies in the inpatient or emergency department setting or studies with adult patients. Implementing research protocols to develop best practices for pediatric prehospital management is challenging due to the infrequent opportunities emergency medical services (EMS) providers have to provide care to pediatric patients. Critically ill or injured children with respiratory distress due to airway compromise or underlying illness such as severe asthma exacerbations are relatively low frequency but high risk events in the prehospital setting. Improving the pipeline from prehospital scientific research to clinical practice for higher quality evidence has been an Institute of Medicine (IOM) recommendation for over a decade. The objective of this article is to describe current evidence guiding prehospital management of children with respiratory distress and to discuss potential research opportunities.
Analysis of Out-of-Hospital Pediatric Intubation by an Australian Helicopter Emergency Medical Service
2017, Annals of Emergency Medicine
Citation Excerpt :
Across all providers, poor performance is often attributed to a lack of frequent experience with pediatric intubation.11,20 Out-of-hospital pediatric airway management has maintained its status as a top research priority for more than a decade.12,21,22 Editor’s Capsule Summary
We examine first-look success in emergency pediatric intubation by a physician-staffed helicopter emergency medical service (EMS).
A database analysis of all pediatric (<16 years) intubations during a 64-month period was undertaken, using data from a prospectively enrolled electronic airway registry form. Recorded findings included patient demographics, operator background, airway intervention including intubation attempts, complications, and critical timings.
Eighty-two subjects were identified during the 64-month study. All patients were successfully intubated. The overall first-look success rate was 75 of 82 (91%), registrars achieving a first-look success rate of 26 of 26 (100%), consultants 16 of 17 (94%), and paramedics 33 of 39 (85%). Overall complication rate was 14%; 84% of cases were rapid sequence induction, whereas 16% were “cold intubations.” Difficult airway indicators were present in 77% of patients.
A high first-look success rate for pediatric intubation was achieved by adult helicopter EMS physicians and intensive care paramedics. To our knowledge, this compares favorably with the rate in published literature in pediatric emergency departments and critical care units.
A tale of two populations: Addressing pediatric needs in the continuum of emergency care
2015, Annals of Emergency Medicine
Citation Excerpt :
Performance measure data have been used to assess access to medical direction for EMS providers treating and transporting pediatric patients, appropriate pediatric equipment and supplies on ambulances to treat children,16 and availability of interfacility transfer agreements designed to expedite the transfer of pediatric patients to the most appropriate facility.1 Several prominent national documents and peer-reviewed studies call attention to major gaps in research for out-of-hospital and hospital-based emergency care, specifically for the pediatric population.20-24 These documents note the limited training of researchers and health professionals in emergency care research.
Nearly 27% of all annual emergency department (ED) visits are pediatric related, a relatively small percentage in comparison to the number of visits from the adult population. The majority of the 31 million children and adolescents access care in nonpediatric facilities and have different clinical presentations and needs than adults. Administered by the Health Resources and Services Administration within the Department of Health and Human Services, the Emergency Medical Services for Children (EMSC) program is a federal entity that aims to ensure that pediatric care is well integrated into the entire emergency medical services system so that no matter where a child lives or travels, he or she can receive appropriate and timely care. The objective of this article is to describe the role of the EMSC program in the development of the pediatric emergency care system. The program is striving to improve pediatric emergency care in a number of ways: EMSC State Partnership grant performance measures address the ability of the out-of-hospital and hospital settings to care for children; the National Pediatric Readiness project works with EDs to ensure that essential resources are present to care for children; regionalization grants focus on the challenges of geographic isolation, access to specialty care, and limited resources; and the targeted issue grants focus on the care of the child in the out-of-hospital setting in which there is a paucity of evidence-based knowledge.
Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study
2009, The Lancet
CT imaging of head-injured children has risks of radiation-induced malignancy. Our aim was to identify children at very low risk of clinically-important traumatic brain injuries (ciTBI) for whom CT might be unnecessary.
We enrolled patients younger than 18 years presenting within 24 h of head trauma with Glasgow Coma Scale scores of 14–15 in 25 North American emergency departments. We derived and validated age-specific prediction rules for ciTBI (death from traumatic brain injury, neurosurgery, intubation >24 h, or hospital admission ≥2 nights).
We enrolled and analysed 42 412 children (derivation and validation populations: 8502 and 2216 younger than 2 years, and 25 283 and 6411 aged 2 years and older). We obtained CT scans on 14 969 (35·3%); ciTBIs occurred in 376 (0·9%), and 60 (0·1%) underwent neurosurgery. In the validation population, the prediction rule for children younger than 2 years (normal mental status, no scalp haematoma except frontal, no loss of consciousness or loss of consciousness for less than 5 s, non-severe injury mechanism, no palpable skull fracture, and acting normally according to the parents) had a negative predictive value for ciTBI of 1175/1175 (100·0%, 95% CI 99·7–100 0) and sensitivity of 25/25 (100%, 86·3–100·0). 167 (24·1%) of 694 CT-imaged patients younger than 2 years were in this low-risk group. The prediction rule for children aged 2 years and older (normal mental status, no loss of consciousness, no vomiting, non-severe injury mechanism, no signs of basilar skull fracture, and no severe headache) had a negative predictive value of 3698/3698 (99·95%, 99·80–99·99) and sensitivity of 61/63 (96·8%, 89·0–99·6). 438 (19.7%) of 2223 CT-imaged patients aged 2 years and older were in this low-risk group. Neither rule missed neurosurgery in validation populations.
These validated prediction rules identified children at very low risk of ciTBIs for whom CT can routinely be obviated.
The Emergency Medical Services for Children Programme of the Maternal and Child Health Bureau, and the Maternal and Child Health Bureau Research Programme, Health Resources and Services Administration, US Department of Health and Human Services.
Economic Value of Out-of-Hospital Emergency Care: A Structured Literature Review
2006, Annals of Emergency Medicine
The evaluation of the impact of out-of-hospital emergency care is a relatively new research focus. As such, there is a compelling need to determine how finite health care resources should be used in this setting. The objective of this study is to conduct a structured review of published economic evaluations of out-of-hospital emergency care to assess its economic value.
A structured literature search and structured review of articles pertaining to the economic value of out-of-hospital care was performed. The bibliographic database MEDLINE was searched for pertinent English-language articles published between 1966 and 2003. The search used the medical subject headings “emergency medical services” and “emergency medical technician” and was limited to the subheading “economics” and crossed with the medical subject heading “economics.” The titles generated by this search were systematically reviewed and limited by topic. Abstracts from the identified titles were reviewed to select a final set of pertinent articles. These articles were further limited based on explicit inclusion and exclusion criteria. Authors used a previously published structured evaluation tool to review the final set of identified articles for quality and content.
The initial MEDLINE search identified 3,533 citations. From this set, 535 potentially relevant abstracts were reviewed. From the abstract review, 46 articles were identified, along with an additional 14 from searching the secondary references. Of these 60 articles, 32 met the review inclusion criteria and were subjected to a full structured review. These studies predominantly addressed the cost of cardiac arrest (n=13, 41%), major trauma (n=8, 25%), and emergency medical services treatment in general (n=8, 25%). Only 14 studies considered the costs and consequences of competing alternatives. Of these, 2 were cost-benefit and 12 were cost-effectiveness evaluations. Two of the 14 studies met all 10 criteria for high-quality economic evaluation, whereas 2 others met none.
There is a paucity of out-of-hospital care literature that addresses cost and economic value. The extant literature is limited in scope, poor in quality, and evaluates small subsets of out-of-hospital emergency care costs. Favorable cost-effectiveness has not been firmly established for most aspects of out-of-hospital emergency care.
Mild traumatic brain injury and postconcussive symptoms in children and adolescents
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^☆: Author affiliations are listed in the Appendix.

^☆☆: Supported in part by project MCH No. 064003 from the Emergency Medical Services for Children program (§1910,US Public Health Services Act); administered by the Health Resources and Services Administration, Maternal and Child Health Bureau in collaboration with the National Highway Traffic Safety Administration, US Department of Transportation.

^★: Address for reprints: James S Seidel, MD, PhD, Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 W Carson Street, Box 21, Torrance, CA 90509.

^★★: This article is being copublished by Journal of Emergency Nursingand Pediatric Emergency Care.

^♢: ^†Deceased.

^♢♢: 0196-0644/99/$8.00 + 0

^♦: 47/1/95319

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Priorities for Research in Emergency Medical Services for Children: Results of a Consensus Conference☆,☆☆,★,★★,♢,♢♢,♦

Abstract

Section snippets

INTRODUCTION

MATERIALS AND METHODS

RESULTS

Ann Emerg Med

Emergency Medical Services for Children: Abstracts of Active Projects FY1994

Pediatric prehospital care in urban and rural areas

Pediatrics

Pediatric deaths and emergency medical services (EMS) in urban and rural areas

Pediatr Emerg Care