Creating a Pediatric Prehospital Destination Decision Tool Using a Modified Delphi Method
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Anders, J.F.; Fishe, J.N.;Fratta, K.A.; Katznelson, J.H.; Levy,M.J.; Lichenstein, R.; Milin, M.G.;Simpson, J.N.;Walls, T.A.;Winger,H.L. Creating a Pediatric PrehospitalDestination Decision Tool Using aModified Delphi Method. Children2021, 8, 658. https://doi.org/10.3390/children8080658
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Attribution 4.0 International (CC BY 4.0)
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This item is likely protected under Title 17 of the U.S. Copyright Law. Unless on a Creative Commons license, for uses protected by Copyright Law, contact the copyright holder or the author.
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Abstract
Decisions for patient transport by emergency medical services (EMS) are individualized; while established guidelines help direct adult patients to specialty hospitals, no such pediatric equivalents are in wide use. When children are transported to a hospital that cannot provide definitive care, care is delayed and may cause adverse events. Therefore, we created a novel evidence-based decision tool to support EMS destination choice. A multidisciplinary expert panel (EP) of stakeholders reviewed published literature. Four facility capability levels for pediatric care were defined. Using a modified Delphi method, the EP matched specific conditions to a facility pediatric-capability level in a draft tool. The literature review and EP recommendations identified seventeen pediatric medical conditions at risk for secondary transport. In the first voting round, two were rejected, nine met consensus for a specific facility capability level, and six did not reach consensus on the destination facility level. A second round reached consensus on a facility level for the six conditions as well as revision of one previously rejected condition. In the third round, the panel selected a visual display format. Finally, the panel unanimously approved the PDTree. Using a modified Delphi technique, we developed the PDTree EMS destination decision tool by incorporating existing evidence and the expertise of a multidisciplinary panel.