Development, implementation and prospective evaluation of guidelines for transfer of severely injured children to specialist centres.
BACKGROUND
Most injured children are appropriately treated at a district general hospital (DGH), but some require transfer to a specialist centre. The objectives of this study were to develop, implement and evaluate triage guidelines for the rapid recognition of injured children who require transfer.


METHODS
This was a prospective, interventional cohort study of the 592 seriously injured children who presented to five regional DGHs during a 51-month period. A multispecialty steering group representing all participating DGHs developed and implemented the guidelines. Data were collected for 24 months before the guidelines were introduced, over the 3-month implementation period and for 24 months afterwards. Outcome measures were referral and management patterns before and after introduction of the guidelines.


RESULTS
For level I (unstable) patients, after the implementation of guidelines there was a 29 per cent increase in the proportion of transfers to a specialist centre (from 40 (68 per cent) of 59 to 32 (97 per cent) of 33; P = 0.003), no admissions to a DGH intensive care unit and all 12 operations were performed at a specialist centre. Guideline users indicated that they were familiar with the guidelines.


CONCLUSIONS
The introduction of triage guidelines within an effective communication network was associated with changes in the management of severely injured children.
Patterson
M
M
Department of Paediatric Surgery, Royal Liverpool Children's NHS Trust, Alder Hey, and Department of Child Health, University of Liverpool, Liverpool, UK.
Jones
M
M
Lloyd
D A
DA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D010360:Patient Transfer / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012017:Referral and Consultation; D016896:Treatment Outcome; D014218:Triage / Q000592:standards*; D014947:Wounds and Injuries / Q000628:therapy*