Creating a Pediatric Prehospital Destination Decision Tool Using a Modified Delphi Method

• Main Authors: Jennifer F. Anders, Jennifer N. Fishe, Kyle A. Fratta, Jessica H. Katznelson, Matthew J. Levy, Richard Lichenstein, Michael G. Milin, Joelle N. Simpson, Theresa A. Walls, Heather L. Winger
• Format: Article
• Language: English
• Published: MDPI AG 2021-07-01
• Series: Children
• Subjects: emergency medical services (EMS); prehospital; pediatrics; emergency care; triage; transport
• Online Access: https://www.mdpi.com/2227-9067/8/8/658

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.