A Modified Delphi Study to Build Consensus on Pediatric-specific Trauma Quality Indicators

Background: Quality improvement efforts across pediatric trauma centers have expanded recently in large part because of the American College of Surgeons Pediatric Trauma Quality Improvement Program. However, consensus on quality indicators (QI) specific to pediatric trauma that measure “quality of care” in this population is lacking. This study aims to identify pediatric-specific trauma QI. Study design: An expert panel of pediatric trauma leaders was convened. The panel met virtually to define and refine potential QI using a modified Delphi method, prioritizing indicators to include representing important QI for pediatric trauma. A comprehensive list of defined QI was created to improve the quality of pediatric trauma care. Results: 14 experts were included in the panel. After 3 rounds of anonymous voting and meetings, 52 QI were chosen, including 25 outcome, 21 process, and 6 structure variables and spanning 6 domains of quality as defined by the Agency for Healthcare Research and Quality. Indicators comprised 22 unchanged from pTQIP, 10 adapted from currently reported in pTQIP, and 20 new. Indicators encompassed unique treatment pathways for pediatric patients, timeliness of care, screening and prevention of future injuries, and long-term outcomes. Conclusion: A modified Delphi method was used to develop a novel list of pediatric trauma QI to inform quality improvement and benchmarking efforts for pediatric trauma care. Analysis of outcomes is required to understand the accuracy and usefulness of these newly proposed and existing indicators. This study serves as a starting point for the incorporation of new QI within national quality improvement initiatives. Study type and Level of Evidence: Survey type study, level 4 evidence.