Improving health outcomes in children

Improving health outcomes in children suffering major injury

Project Members - Macquarie University

Rebecca Mitchell - Associate Professor  E: r.mitchell@mq.edu.au

Project Main Description

A review of 1,138 severely injured children in New South Wales (NSW) identified that children treated at adult trauma centres were 3 to 6 times less likely to survive than those who received definitive treatment at a paediatric trauma centre. Yet, there has been no comprehensive assessment of the processes of care and the systems for treating severe paediatric injury in Australia, nor have any strategies been developed to improve health care services and health outcomes. This research is identifying the most effective treatment pathways to ensure the best possible health outcomes for seriously injured children.

This research has involved a review of care provision, care pathways, and survival following severe paediatric injury in NSW. Pre-hospital and in-hospital care provision was peer-reviewed, paediatric trauma outcomes, such as mortality and function, monitored and health service delivery outcomes, such as cost and hospital length of stay, have been assessed.

Research evidence from this study into practice

The peer-review panel identified that non-cuffed endotracheal tubes were being used NSW Ambulance paramedics and that the use of these tubes was resulting in potential compromised ventilation for this patient group, and children were requiring reintubation on arrival to hospital. These preliminary findings were formally communicated to NSW Ambulance in October 2016. At the time of receiving the preliminary findings NSW Ambulance were in the process of reviewing airway management practices, and this provided further evidence for change. NSW Ambulance has since changed their practice from using non-cuffed endotracheal tubes to cuffed tubes for paediatric airway management.

Publications

• Curtis, K. Kennedy B. Lam M. Mitchell R. Black D. Burns B. Loudfoot A. Tall G. Dinh M. Beech C. Holland A. (2020) Pre-hospital care and transport costs of severely injured children in NSW Australia. Injury 51, 2581-2587.
• Curtis K. Kennedy B. Lam M. Mitchell R. Black D. Burns B. White L. Loudfoot A. D’Amato A. Dinh M. Holland A. (2020) Cause, treatment costs and 12-month functional outcomes of children with major injury in NSW, Australia. Injury 51 (9) 2066-2075.
• Curtis K. Kennedy B. Holland A J. Tall G. Smith H. Soundappan SV. Burns B. Mitchell RJ. Wilson K. Loudfoot A. Dinh M. Lyons T. Gillen T. Dickinson S. (in-press, accepted 16 January 2019)  Identifying areas for improvement in paediatric trauma care in NSW Australia using a clinical, system and human factors peer-review tool. Injury
• Curtis K. Mitchell R. McCarthy A. Wilson K. Van C. Kennedy B. Tall G. Holland A. Foster K. Dickinson S. Stelfox H. (2017)  Development of the major trauma case review tool. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 25:20.
• Curtis K. McCarthy A. Mitchell R. Black D. Foster K. Jan S. Burns B. Tall G. Rigby O. Kennedy B. Holland A. (2016) Paediatric trauma systems and their impact on the health outcomes of severely injured children: protocol for a mixed methods cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 24(1): 1-8.

Project Sponsors

NHMRC Partnership Project APP1092499

Collaborative Partners

• Australian Trauma Quality Improvement Program
• Day of Difference Foundation
• NSW Agency for Clinical Innovation
• NSW Ambulance and Helicopter Emergency Medical Service
• NSW Institute of Trauma and Injury Management
• NSW Ministry of Health

Collaborators

• Associate Professor Kate Curtis (Project Lead), Sydney Nursing School, University of Sydney
• Professor Andrew Holland, Sydney Medical School, University of Sydney
• Professor Deborah Black, Faculty of Health Sciences, University of Sydney
• Professor Stephen Jan, Sydney Medical School, University of Sydney
• Professor Kim Foster, Nursing and Midwifery, University of Canberra
• Professor Johan Duflou, Department of Forensic Medicine, Sydney
• Dr Oran Rigby, NSW Institute of Trauma and Injury Management
• Associate Professor Brian Burns, Greater Sydney Area Helicopter Emergency Medical Service

Related Projects

CareTrack Kids

Better outcomes for injured children

Project Status

Completed

Centres Related to this Project

Centre for Healthcare Resilience and Implementation Science