DOI: 10.3886/icpsr39210.v1
title: Improving Family-Centered Pediatric Trauma Care: The Standard of Care Versus the Virtual Pediatric Trauma Center, California, 2020-2022
title: Version 1

description: The current standard of care in the treatment of children with physical trauma presenting to non-designated pediatric trauma centers is consultation with a pediatric trauma center by telephone. This includes contacting a pediatric trauma specialist and transferring any child with a potentially serious injury to a regionalized Level I pediatric trauma center. This approach to care frequently results in medically unnecessary transfers and may place undue burdens on families. A newer model of care, the Virtual Pediatric Trauma Center (VPTC), uses telemedicine to make the expertise of a Level I pediatric trauma center virtually available to any hospital. The VPTC is a model of care that utilizes telemedicine for acutely injured children presenting to non-pediatric trauma center hospitals to obtain consultations from pediatric trauma specialists. While the use of the VPTC model of care is increasing, there have been no comparisons of the VPTC to standard care of injured children at non-designated trauma centers with respect to patient- and family-centered outcomes. The goal of this study is to compare the current standard of care to the VPTC with respect to family-centered outcomes developed by parents and community advisory boards.
description: The purpose of this study was to compare the current standard of care to the Virtual Pediatric Trauma Center (VPTC) with respect to family-centered outcomes developed by parents and community advisory boards.
description: This study included a randomized trial to compare parent/family experience of care, parent/family distress, transfer rates, 30-day healthcare utilization, and out-of-pocket (OOP) costs for parents/families between the VPTC model of care and the current standard of care where the telephone is used to conduct consultations with specialists at a regional Level I pediatric trauma center. Participants included children younger than 18 years old with acute physical trauma presenting to one of 11 participating non-pediatric trauma center hospitals in northern California, including Level II, Level III, and non-designated trauma centers.
Over two years (November 2020 - November 2022), the research team conducted a stepped wedge design trial where sites started with the standard of care (telephone consultation with the trauma team), then switched to the Virtual Pediatric Trauma Center (VPTC) model of care (telemedicine consultation with the trauma team). To compare parent/family experience of care at 3-days and parent/family distress at 3- and 30-days post injury, the research team used the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Hospital survey and the State-Trait Anxiety Inventory Form Y survey. CAHPS items were normalized so that the theoretical range was 0 to 1 and then averaged to form overall and subscale scores. Adjusted mean differences were calculated using mixed-effects regression models accounting for a small number of potential confounders, with splines used to account for calendar time.
To compare hospital utilization rates, the research team calculated the number of initial hospitalizations and subsequent emergency department and/or hospitalizations within 30 days of injury and compared the adjusted hospital charges between the two cohorts. To measure out-of-pocket (OOP) costs at 3- and 30-days post injury, surveys were distributed to parents/guardians asking about medical and non-medical related expenses. Adjusted odds ratios for hospital utilization and adjusted mean differences for hospital costs and out-of-pocket costs were calculated using mixed-effects regression models accounting for known and potential confounders, with splines used to account for calendar time. All outcomes were compared using intention-to-treat (ITT) analysis.
description: This study includes variables regarding patient demographics, healthcare experience, health history, and medical location transfer history.
description: Response Rates: 345 (58%) families/parents completed a 3-day Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
For the State-Trait Anxiety Inventory survey:

336 (56.4%) families/parents completed a 3-day survey
325 (54.6%) completed a 30-day survey
315 (52.9%) completed a 60-day survey
319 (53.6%) completed a 90-day survey
description: Presence of Common Scales: Two Likert-type scales were included:

To compare the differences in experience of care at 3-days between the two models of care, the research team used questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Hospital survey with additional questions developed with community advisory groups and a parent co-investigator.
To compare the differences in parent/family distress at 3- and 30-days between the two models of care, the research team used the state anxiety portion of the State-Trait Anxiety Inventory Form Y.
description: Participants were screened for eligibility by review of electronic medical record (EMR) data from a Transfer Center report. This report included patients who presented to one of the participating study sites for a transfer consultation to UC Davis Trauma, Orthopedics, or Neurosurgery services, which was congruent with eligibility criteria (a transfer consultation from a participating site). Enrollment ran from November 2020 through November 2022.
706 participants were screened for eligibility. Of those, 73 did not meet inclusion criteria and 38 were excluded. Reasons for exclusion include:

Ward of the state
Received CPR
Died before 3-day survey was administered
Received CPR and died before 3-day survey was administered
Parent/guardian not present with child during emergency department experience
Study participant agreement not in place due to site replacement
The remaining 595 were randomized to receive the standard of care or the VPTC intervention. 226 participants were randomized to receive the standard and care and 369 were randomized to receive the VPTC intervention. All participants assigned to the standard of care received the standard of care. 165 participants of the 369 randomized to the intervention received the VPTC intervention.
description: Datasets: 
DS0: Study-Level Files
DS1: Baseline Data
DS2: Day 3 Survey Data
DS3: Survey Data (Day 3, 30, 60, 90)
DS4: Patient Hospital Utilization and Out-of-Pocket Cost Data
description: Children younger than 18 years old with acute physical trauma presenting to one of 11 participating non-pediatric trauma center hospitals in northern California.
description: web-based survey