Impact of Interfacility Transport Method and Specialty Teams on Outcomes of Pediatric Trauma Patients.

OBJECTIVE: The aim of the study was to evaluate the impact of ground versus air transport and use of pediatric specialty versus generalist transport teams on outcomes of pediatric trauma victims requiring interfacility transport. METHODS: A retrospective review of our hospital's trauma registry database was performed. Children with traumatic injuries who were transported from a referring hospital by either our pediatric specialty transport team or an outside generalist transport team were included in the analysis. Comparisons were made by mode of transport (air vs ground), team type (specialty vs generalist), and by transport mode and team type combined. RESULTS: Total transport time was significantly shorter for generalist air transport than other modes. Severity of injury as determined by Pediatric Trauma Score (PTS) was equivalent for all patients at the referring hospital, but there was a statistically significant greater decrease (worsening) in PTS from referral to arrival for generalist team air transports versus all other transport modes. Similarly, there was a statistically significant greater decrease (worsening) in Glasgow Coma Score from referral to arrival for generalist team air transport versus all other transport modes. Hospital discharge disposition to home was greater for all ground teams versus air teams and for specialty team air versus generalist team air. CONCLUSIONS: In our system, air transport by a generalist team occurred more rapidly than ground or air transport by a specialty team. However, generalist air transport is associated with significant worsening in patients' PTS and Glasgow Coma Score despite similar severity of injury at referral, and differences in hospital discharge disposition were present.

Implementation of a standardized screening program for risk of posttraumatic stress disorder among youth hospitalized with injury.

Children with pediatric injury and their parents are at risk for developing posttraumatic stress disorder (PTSD). Although challenging to implement, standardized screening for risk of developing PTSD can identify families most at risk. The current retrospective, chart review study evaluated the implementation of a clinical program that integrated screening for risk of PTSD into standard care for youth admitted to a Level I pediatric trauma center due to injury. Advanced practice nurses administered the Screening Tool for Early Predictors of PTSD (STEPP), a brief screen that evaluates risk of developing PTSD for injured children (ages 8-17 years) and their parents. Positive parent or child STEPPs prompted a referral to psychology for an inpatient consultation. Data were collected via review of electronic medical records and trauma program registry, including demographic, injury, and admission information, completion of and result on the STEPP, and completion of a psychology consultation. During the 2.5 year study period, 1,153 youth (birth-17 years) were admitted due to injury. Among those eligible for the STEPP (i.e., ≥8 years; N = 562), 67% completed the STEPP. Among those who completed the STEPP, 25% had positive parent or child screens and 68% of these completed an inpatient psychology consultation. Standardized screening was related to significantly higher use of inpatient psychology services compared with a control sample not eligible for screening (i.e., <8 years). STEPP scores varied by demographic, admission and injury factors. Results suggest standardized screening is feasible and improves reach of trauma-informed care. Barriers and facilitators of this screening program are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).