title: Variability in the structure and care processes for critically injured children: A multicenter survey of trauma bay and intensive care units.
abstract: OBJECTIVE
  Evaluate national variation in structure and care processes for critically injured children.
  
  
  METHODS
  Institutions 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.
  
  
  RESULTS
  About 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.
  
  
  CONCLUSIONS
  Variability 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.
authors.affiliation: Harborview Injury Prevention and Research Center, Box #359960, 325 Ninth Avenue, Seattle, WA 98104; Department of Surgery, University of Washington, Box # 356410, 1959 NE Pacific St, Seattle, WA 98195. Electronic address: flynnobr@uw.edu.
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Flynn-O'Brien
authors.affiliation: Harborview Injury Prevention and Research Center, Box #359960, 325 Ninth Avenue, Seattle, WA 98104.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Thompson
authors.affiliation: Virtual Pediatric Systems, LLC, 470W Sunset Blvd #440, Los Angeles, CA 90027.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Gall
authors.affiliation: Department of Surgery, University of Louisville and Kosair Children's Hospital, 315 E. Broadway, Suite 565, Louisville, KY 40202.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Fallat
authors.affiliation: Virtual Pediatric Systems, LLC, 470W Sunset Blvd #440, Los Angeles, CA 90027; Department of Pediatrics, Medical College of Wisconsin, 9000W. Wisconsin Ave., MS #681, Milwaukee, WI 53226.
authors.forename: Tom B
authors.initials: TB
authors.lastname: Rice
authors.affiliation: Harborview Injury Prevention and Research Center, Box #359960, 325 Ninth Avenue, Seattle, WA 98104; Department of Pediatrics, University of Washington, Box #359774, 325 Ninth Avenue, Seattle, WA 98104.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Critical care; Outcome and process assessment; Patient care; Pediatrics; Quality; Trauma