Trauma Routing Algorithm for Pediatrics

NCT03359421 | Completed

• 1 other identifier: IRB00047353
• Study Type: observational
• Target: 4,801
• Locations: 1 country
• Sites: 1

Brief Summary

Traumatic injury is the leading cause of pediatric death in the United States for those forty-four years of age and younger. Pediatric trauma patients generally have reduced mortality when treated at pediatric trauma centers rather than at adult centers or non-tertiary care facilities. However, nearly half the US pediatric population lives over fifty miles from a Level I or II Trauma Center. While air ambulances are readily available in many jurisdictions, few guidelines and little evidence dictate their appropriate use, especially with regard to pediatric trauma. Previous research is mixed regarding mortality benefit from helicopter Emergency Medical Services (EMS) in injured children. Previous attempts to develop appropriate field triage criteria have failed due to poor sensitivity and specificity for identifying the critically injured child. The current high rate of overtriage is particularly concerning in today's cost-conscious medical community. This research study aims to categorize pre-hospital pediatric trauma in North Carolina, to determine what benefits helicopter EMS provides in the North Carolina trauma system, and to formulate an enhanced screening tool for pre-hospital use to help determine which patients are suitable candidates for helicopter EMS transport.

Conditions

Pediatric All; Trauma

Keywords

prehospital; aeromedical; trauma; ems; helicopter

Outcome Measures

Primary Outcomes (1)

• Survival

  Patient survival

  approximately 1 month or less

Study Arms (2)

Aeromedical transport

Patients transported to trauma center by helicopter

Ground transport

Patients transported to trauma center by ground ambulance

Eligibility Criteria

• Age: 2 Days - 18 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)
• Sampling Method: Probability Sample

Study Population

Patients \<16 years old involved in trauma that were transported to a North Carolina Trauma Center

You may qualify if:

• Pediatric trauma victims 0-16 years old who are reported in the North Carolina Trauma Registry after presenting to a North Carolina Trauma Center between January 1st, 2013 and October, 2017.

You may not qualify if:

• Interfacility transport patients are excluded

Sponsors & Collaborators

• Wake Forest University Health Sciences: lead

Study Sites (1)

Wake Forest University School of Medicine

Winston-Salem, North Carolina, 27057, United States

Location

Related Publications (16)

• Arfken CL, Shapiro MJ, Bessey PQ, Littenberg B. Effectiveness of helicopter versus ground ambulance services for interfacility transport. J Trauma. 1998 Oct;45(4):785-90. doi: 10.1097/00005373-199810000-00031.

  PMID: 9783622 BACKGROUND

• Baxt WG, Moody P. The impact of a rotorcraft aeromedical emergency care service on trauma mortality. JAMA. 1983 Jun 10;249(22):3047-51.

  PMID: 6854826 BACKGROUND

• Biewener A, Aschenbrenner U, Rammelt S, Grass R, Zwipp H. Impact of helicopter transport and hospital level on mortality of polytrauma patients. J Trauma. 2004 Jan;56(1):94-8. doi: 10.1097/01.TA.0000061883.92194.50.

  PMID: 14749573 BACKGROUND

• Bledsoe BE, Wesley AK, Eckstein M, Dunn TM, O'Keefe MF. Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis. J Trauma. 2006 Jun;60(6):1257-65; discussion 1265-6. doi: 10.1097/01.ta.0000196489.19928.c0.

  PMID: 16766969 BACKGROUND

• Chappell VL, Mileski WJ, Wolf SE, Gore DC. Impact of discontinuing a hospital-based air ambulance service on trauma patient outcomes. J Trauma. 2002 Mar;52(3):486-91. doi: 10.1097/00005373-200203000-00012.

  PMID: 11901324 BACKGROUND

• Englum BR, Rialon KL, Kim J, Shapiro ML, Scarborough JE, Rice HE, Adibe OO, Tracy ET. Current use and outcomes of helicopter transport in pediatric trauma: a review of 18,291 transports. J Pediatr Surg. 2017 Jan;52(1):140-144. doi: 10.1016/j.jpedsurg.2016.10.030. Epub 2016 Oct 27.

  PMID: 27852453 BACKGROUND

• Floccare DJ, Stuhlmiller DF, Braithwaite SA, Thomas SH, Madden JF, Hankins DG, Dhindsa H, Millin MG. Appropriate and safe utilization of helicopter emergency medical services: a joint position statement with resource document. Prehosp Emerg Care. 2013 Oct-Dec;17(4):521-5. doi: 10.3109/10903127.2013.804139. Epub 2013 Jul 8.

  PMID: 23834231 BACKGROUND

• Lerner EB, Drendel AL, Cushman JT, Badawy M, Shah MN, Guse CE, Cooper A. Ability of the Physiologic Criteria of the Field Triage Guidelines to Identify Children Who Need the Resources of a Trauma Center. Prehosp Emerg Care. 2017 Mar-Apr;21(2):180-184. doi: 10.1080/10903127.2016.1233311. Epub 2016 Oct 6.

  PMID: 27710155 BACKGROUND

• Michailidou M, Goldstein SD, Salazar J, Aboagye J, Stewart D, Efron D, Abdullah F, Haut ER. Helicopter overtriage in pediatric trauma. J Pediatr Surg. 2014 Nov;49(11):1673-7. doi: 10.1016/j.jpedsurg.2014.08.008. Epub 2014 Nov 6.

  PMID: 25475816 BACKGROUND

• Mitchell AD, Tallon JM, Sealy B. Air versus ground transport of major trauma patients to a tertiary trauma centre: a province-wide comparison using TRISS analysis. Can J Surg. 2007 Apr;50(2):129-33.

  PMID: 17550717 BACKGROUND

• Moront ML, Gotschall CS, Eichelberger MR. Helicopter transport of injured children: system effectiveness and triage criteria. J Pediatr Surg. 1996 Aug;31(8):1183-6; discussion 1187-8. doi: 10.1016/s0022-3468(96)90114-1.

  PMID: 8863261 BACKGROUND

• Potoka DA, Schall LC, Gardner MJ, Stafford PW, Peitzman AB, Ford HR. Impact of pediatric trauma centers on mortality in a statewide system. J Trauma. 2000 Aug;49(2):237-45. doi: 10.1097/00005373-200008000-00009.

  PMID: 10963534 BACKGROUND

• Sathya C, Alali AS, Wales PW, Scales DC, Karanicolas PJ, Burd RS, Nance ML, Xiong W, Nathens AB. Mortality Among Injured Children Treated at Different Trauma Center Types. JAMA Surg. 2015 Sep;150(9):874-81. doi: 10.1001/jamasurg.2015.1121.

  PMID: 26106848 BACKGROUND

• Stewart CL, Metzger RR, Pyle L, Darmofal J, Scaife E, Moulton SL. Helicopter versus ground emergency medical services for the transportation of traumatically injured children. J Pediatr Surg. 2015 Feb;50(2):347-52. doi: 10.1016/j.jpedsurg.2014.09.040. Epub 2014 Oct 1.

  PMID: 25638635 BACKGROUND

• Sullivent EE, Faul M, Wald MM. Reduced mortality in injured adults transported by helicopter emergency medical services. Prehosp Emerg Care. 2011 Jul-Sep;15(3):295-302. doi: 10.3109/10903127.2011.569849. Epub 2011 Apr 27.

  PMID: 21524205 BACKGROUND

• Webman RB, Carter EA, Mittal S, Wang J, Sathya C, Nathens AB, Nance ML, Madigan D, Burd RS. Association Between Trauma Center Type and Mortality Among Injured Adolescent Patients. JAMA Pediatr. 2016 Aug 1;170(8):780-6. doi: 10.1001/jamapediatrics.2016.0805.

  PMID: 27368110 BACKGROUND

MeSH Terms

Conditions

Precursor Cell Lymphoblastic Leukemia-Lymphoma; Wounds and Injuries

Condition Hierarchy (Ancestors)

Leukemia, Lymphoid; Leukemia; Neoplasms by Histologic Type; Neoplasms; Hematologic Diseases; Hemic and Lymphatic Diseases; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Immune System Diseases

Study Officials

• Jason Stopyra, MD

  Wake Forest University Health Sciences

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: OTHER
• Target Duration: 1 Month
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 27, 2017
• First Posted: December 2, 2017
• Study Start: November 27, 2017
• Primary Completion: December 15, 2017
• Study Completion: May 31, 2020
• Last Updated: December 10, 2021

Record last verified: 2021-12

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)