Evidence-Informed Quality Indicators for Pediatric Trauma Care

Lynne Moore^{1

2}, Natalie L Yanchar³, Pier-Alexandre Tardif⁴, Matthew Weiss⁵, Emilie Beaulieu⁶, Antonia Stang⁷, Isabelle Gagnon⁸, Belinda Gabbe⁹, Thomas Stelfox^{10

11

12}, Ian Pike^{13

14}, Alison Macpherson¹⁵, Simon Berthelot¹, Terry Klassen¹⁶, Suzanne Beno¹⁷, Sasha Carsen¹⁸, Mélanie Labrosse¹⁹, Roger Zemek²⁰, Fran Priestap²¹, Brett Burstein^{8

22}, Katherine E Remick²³, Keith Owen Yeates^{24

25}, Neil Merritt²⁶, Nathan Kuppermann²⁷, Ruth Loellgen²⁸, Naomi Davis²⁹, Fiona Lecky^{30

31}, Warwick Teague³², Andrew Holland³³, Christian Malo³⁴, Marianne Beaudin³⁵, Patrick Archambault⁴, Gabrielle Freire³⁶; Quality Indicators in Pediatric Trauma Care Expert Consensus Group

Affiliations

¹ Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus), Québec, Québec, Canada.
² Department of Social and Preventative Medicine, Université Laval, Québec, Québec, Canada.
³ Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
⁴ Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Québec, Canada.
⁵ Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Université Laval, Québec, Québec, Canada.
⁶ Département de Pédiatrie, Faculté de Médecine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Quebec, Canada.
⁷ Department of Pediatrics, Emergency Medicine, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁸ Montreal Children's Hospital, Division of Pediatric Emergency Medicine, McGill University Health Centre, Montréal, Quebec, Canada.
⁹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
¹⁰ Department of Critical Care Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
¹¹ Department of Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
¹² Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
¹³ Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.
¹⁴ BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada.
¹⁵ School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
¹⁶ George & Fay Yee Centre for Health Care Innovation, Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁷ Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
¹⁸ Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
¹⁹ Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.
²⁰ Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
²¹ Trauma Program, London Health Sciences Centre,, London, Ontario, Canada.
²² Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montréal, Quebec, Canada.
²³ Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin.
²⁴ Department of Psychology, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
²⁵ Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
²⁶ Department of Surgery, Western University, London, Ontario, Canada.
²⁷ The Departments of Pediatrics and Emergency Medicine, George Washington School of Medicine and Health Sciences, Children's National Hospital, Washington, DC.
²⁸ Department of Pediatric Emergency Medicine, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
²⁹ Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
³⁰ School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
³¹ Trauma Audit and Research Network, United Kingdom.
³² Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.
³³ The Burns Unit, The Children's Hospital at Westmead Burns Research Institute, Westmead, New South Wales, Australia.
³⁴ Département de Médicine Familiale et de Médicine d'Urgence, Faculté de Médecine, Université Laval, Québec City, Québec, Canada.
³⁵ Department of Paediatric Surgery, Sainte-Justine Hospital, Université de Montréal, Montréal, Québec, Canada.
³⁶ Division of Emergency Medicine, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.

PMID: 40163207
PMCID: PMC11959479 (available on 2026-03-31)
DOI: 10.1001/jamapediatrics.2025.0036

Evidence-Informed Quality Indicators for Pediatric Trauma Care

Lynne Moore et al. JAMA Pediatr. 2025.

. 2025 Jun 1;179(6):666-674.

doi: 10.1001/jamapediatrics.2025.0036.

Authors

Affiliations

¹ Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus), Québec, Québec, Canada.
² Department of Social and Preventative Medicine, Université Laval, Québec, Québec, Canada.
³ Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
⁴ Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Québec, Canada.
⁵ Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Université Laval, Québec, Québec, Canada.
⁶ Département de Pédiatrie, Faculté de Médecine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Quebec, Canada.
⁷ Department of Pediatrics, Emergency Medicine, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁸ Montreal Children's Hospital, Division of Pediatric Emergency Medicine, McGill University Health Centre, Montréal, Quebec, Canada.
⁹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
¹⁰ Department of Critical Care Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
¹¹ Department of Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
¹² Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
¹³ Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.
¹⁴ BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada.
¹⁵ School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
¹⁶ George & Fay Yee Centre for Health Care Innovation, Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁷ Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
¹⁸ Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
¹⁹ Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.
²⁰ Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
²¹ Trauma Program, London Health Sciences Centre,, London, Ontario, Canada.
²² Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montréal, Quebec, Canada.
²³ Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin.
²⁴ Department of Psychology, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
²⁵ Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
²⁶ Department of Surgery, Western University, London, Ontario, Canada.
²⁷ The Departments of Pediatrics and Emergency Medicine, George Washington School of Medicine and Health Sciences, Children's National Hospital, Washington, DC.
²⁸ Department of Pediatric Emergency Medicine, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
²⁹ Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
³⁰ School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
³¹ Trauma Audit and Research Network, United Kingdom.
³² Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.
³³ The Burns Unit, The Children's Hospital at Westmead Burns Research Institute, Westmead, New South Wales, Australia.
³⁴ Département de Médicine Familiale et de Médicine d'Urgence, Faculté de Médecine, Université Laval, Québec City, Québec, Canada.
³⁵ Department of Paediatric Surgery, Sainte-Justine Hospital, Université de Montréal, Montréal, Québec, Canada.
³⁶ Division of Emergency Medicine, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.

PMID: 40163207
PMCID: PMC11959479 (available on 2026-03-31)
DOI: 10.1001/jamapediatrics.2025.0036

Abstract

Importance: Despite the unique physiological characteristics and health care needs of pediatric trauma patients, there is a lack of quality indicators (QIs) based on pediatric-specific evidence to support quality improvement in this population.

Objective: To develop a consensus-based set of QIs for acute pediatric trauma care that considers evidence on effectiveness, safety, cost-effectiveness, equity, and caregiver perspectives and is applicable in pediatric and nonpediatric trauma centers.

Design, setting, and participants: A modified Research and Development (RAND)/University of California Los Angeles (UCLA) expert consensus study was conducted consisting of an online survey and a virtual workshop, led by an independent moderator. Panelists represented key areas of pediatric trauma patient management, diverse care settings (from level I pediatric trauma centers to level III referring centers), 5 high-resource countries, and caregivers. Data were analyzed from May to August 2024.

Exposure: Likert-scale ratings of 41 QIs.

Main outcomes and measures: Panelists rated 41 QIs on a 7-point Likert scale according to 4 criteria: importance, supporting evidence, actionability, and measurability. QIs with a global score of 24 of 28 or greater and an importance score of 6 of 7 or greater were considered accepted by consensus.

Results: A total of 65 experts were invited, of whom 59 accepted (91%; 25 over 50 years of age [44.7%]; 34 female [60.7%]), 56 (95%) completed the first round, and 54 (92%) completed both rounds. Twenty-three QIs were selected covering key areas of acute pediatric trauma management (eg, transfer to a pediatric trauma center for neurotrauma or major multisystem trauma, documentation of vital signs, early rehabilitation, nutritional support), the most common types of injuries (eg, hypertonic saline in severe traumatic brain injury, stabilization of femoral shaft fractures, nonoperative management of solid organ injuries), value in care (eg, imaging in children at low risk on a clinical decision rule), patient-centered care (eg, designated support person, caregiver presence), and equity (eg, mental health screening).

Conclusions: These results may be used by trauma quality improvement programs in high-resource countries to select context-specific quality indicators to improve the effectiveness, safety, cost-effectiveness, equity, and patient-centered nature of pediatric trauma care.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Zemek reported that his program of research has received financial support through competitively-funded research grants from Canadian Institutes of Health Research (CIHR), Ontario Neurotrauma Foundation, Physician Services Incorporated Foundation, CHEO Foundation, Ontario Brain Institute, National Football League, Ontario Ministry of Health, Public Health Agency of Canada, Health Canada, Parachute Canada and Ontario SPOR Support Unit, and Health Resources and Services Administration; receiving support as a tier 1 clinical research chair in pediatric concussion from University of Ottawa; serving on the board of directors for North American Brain Injury Society (NABIS), which is a volunteer (unpaid) role; and serving as scientific director, founding partner, and minority shareholder of 360 Concussion Care (a learning health system and network of interdisciplinary concussion clinics in Ontario) outside the submitted work. Dr Lecky reported receiving advisor fees from the National Institute of Health and Care Excellence UK outside the submitted work. Dr Teague reported receiving a philanthropic grant from the Royal Children's Hospital Foundation, which provides salary support for academic activities as distinct from clinical activities. Dr Archambault reported receiving grants from CIHR during the conduct of the study. No other disclosures were reported.

References

1. Centers for Disease Control and Prevention . Child injury. Accessed March 15, 2023. https://www.cdc.gov/vitalsigns/pdf/2012-04-vitalsigns.pdf
1. UNICEF . World report on child injury prevention. Accessed May 13, 2020. https://www.who.int/publications/i/item/9789241563574
1. Moore L, Lavoie A, Bourgeois G, Lapointe J. Donabedian’s structure-process-outcome quality of care model: validation in an integrated trauma system. J Trauma Acute Care Surg. 2015;78(6):1168-1175. doi:10.1097/TA.0000000000000663 - DOI - PubMed
1. Hornor MA, Hoeft C, Nathens AB. Quality benchmarking in trauma: from the NTDB to TQIP. Curr Trauma Rep. 2018;4:160-169. doi:10.1007/s40719-018-0127-1 - DOI
1. American College of Surgeons . Trauma quality improvement program. Accessed August 26, 2020. https://www.facs.org/quality-programs/trauma/tqp/center-programs/tqip

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.
- Silverchair Information Systems
Medical
- MedlinePlus Consumer Health Information
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Evidence-Informed Quality Indicators for Pediatric Trauma Care

Affiliations

Evidence-Informed Quality Indicators for Pediatric Trauma Care

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical