Improving Family-Centered Pediatric Trauma Care: The Standard of Care Versus the Virtual Pediatric Trauma Center, California, 2020-2022 (ICPSR 39210)

Version Date: Jul 14, 2025

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Principal Investigator(s):
James Marcin, University of California, Davis Health

https://doi.org/10.3886/ICPSR39210.v1

Version V1

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Summary

The current standard of care in the treatment of children with physical trauma presenting to non-designated pediatric trauma centers is consultation with a pediatric trauma center by telephone. This includes contacting a pediatric trauma specialist and transferring any child with a potentially serious injury to a regionalized Level I pediatric trauma center. This approach to care frequently results in medically unnecessary transfers and may place undue burdens on families. A newer model of care, the Virtual Pediatric Trauma Center (VPTC), uses telemedicine to make the expertise of a Level I pediatric trauma center virtually available to any hospital. The VPTC is a model of care that utilizes telemedicine for acutely injured children presenting to non-pediatric trauma center hospitals to obtain consultations from pediatric trauma specialists. While the use of the VPTC model of care is increasing, there have been no comparisons of the VPTC to standard care of injured children at non-designated trauma centers with respect to patient- and family-centered outcomes. The goal of this study is to compare the current standard of care to the VPTC with respect to family-centered outcomes developed by parents and community advisory boards.

Citation

Marcin, James. Improving Family-Centered Pediatric Trauma Care: The Standard of Care Versus the Virtual Pediatric Trauma Center, California, 2020-2022. Inter-university Consortium for Political and Social Research [distributor], 2025-07-14. https://doi.org/10.3886/ICPSR39210.v1

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Funding

Patient-Centered Outcomes Research Institute (PCORI) (IHS-2019C1-16093)

Subject Terms

Geographic Coverage

Restrictions

Access to the data in this collection is restricted. Users interested in obtaining these data must complete a Restricted Data Use Agreement, specify the reason for the request, and obtain IRB approval or notice of exemption for their research.

Distributor(s)

Inter-university Consortium for Political and Social Research
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Time Period(s)

2020 -- 2023

Date of Collection

2020-11-30 -- 2023-03-14
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Study Purpose

The purpose of this study was to compare the current standard of care to the Virtual Pediatric Trauma Center (VPTC) with respect to family-centered outcomes developed by parents and community advisory boards.

Study Design

This study included a randomized trial to compare parent/family experience of care, parent/family distress, transfer rates, 30-day healthcare utilization, and out-of-pocket (OOP) costs for parents/families between the VPTC model of care and the current standard of care where the telephone is used to conduct consultations with specialists at a regional Level I pediatric trauma center. Participants included children younger than 18 years old with acute physical trauma presenting to one of 11 participating non-pediatric trauma center hospitals in northern California, including Level II, Level III, and non-designated trauma centers.

Over two years (November 2020 - November 2022), the research team conducted a stepped wedge design trial where sites started with the standard of care (telephone consultation with the trauma team), then switched to the Virtual Pediatric Trauma Center (VPTC) model of care (telemedicine consultation with the trauma team). To compare parent/family experience of care at 3-days and parent/family distress at 3- and 30-days post injury, the research team used the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Hospital survey and the State-Trait Anxiety Inventory Form Y survey. CAHPS items were normalized so that the theoretical range was 0 to 1 and then averaged to form overall and subscale scores. Adjusted mean differences were calculated using mixed-effects regression models accounting for a small number of potential confounders, with splines used to account for calendar time.

To compare hospital utilization rates, the research team calculated the number of initial hospitalizations and subsequent emergency department and/or hospitalizations within 30 days of injury and compared the adjusted hospital charges between the two cohorts. To measure out-of-pocket (OOP) costs at 3- and 30-days post injury, surveys were distributed to parents/guardians asking about medical and non-medical related expenses. Adjusted odds ratios for hospital utilization and adjusted mean differences for hospital costs and out-of-pocket costs were calculated using mixed-effects regression models accounting for known and potential confounders, with splines used to account for calendar time. All outcomes were compared using intention-to-treat (ITT) analysis.

Sample

Participants were screened for eligibility by review of electronic medical record (EMR) data from a Transfer Center report. This report included patients who presented to one of the participating study sites for a transfer consultation to UC Davis Trauma, Orthopedics, or Neurosurgery services, which was congruent with eligibility criteria (a transfer consultation from a participating site). Enrollment ran from November 2020 through November 2022.

706 participants were screened for eligibility. Of those, 73 did not meet inclusion criteria and 38 were excluded. Reasons for exclusion include:

  • Ward of the state
  • Received CPR
  • Died before 3-day survey was administered
  • Received CPR and died before 3-day survey was administered
  • Parent/guardian not present with child during emergency department experience
  • Study participant agreement not in place due to site replacement
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    The remaining 595 were randomized to receive the standard of care or the VPTC intervention. 226 participants were randomized to receive the standard and care and 369 were randomized to receive the VPTC intervention. All participants assigned to the standard of care received the standard of care. 165 participants of the 369 randomized to the intervention received the VPTC intervention.

    Time Method

    Longitudinal

    Universe

    Children younger than 18 years old with acute physical trauma presenting to one of 11 participating non-pediatric trauma center hospitals in northern California.

    Unit(s) of Observation

    Individual

    Data Type(s)

    Mode of Data Collection

    Description of Variables

    This study includes variables regarding patient demographics, healthcare experience, health history, and medical location transfer history.

    Response Rates

    345 (58%) families/parents completed a 3-day Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.

    For the State-Trait Anxiety Inventory survey:

  • 336 (56.4%) families/parents completed a 3-day survey
  • 325 (54.6%) completed a 30-day survey
  • 315 (52.9%) completed a 60-day survey
  • 319 (53.6%) completed a 90-day survey

    • Presence of Common Scales

    Two Likert-type scales were included:

  • To compare the differences in experience of care at 3-days between the two models of care, the research team used questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Hospital survey with additional questions developed with community advisory groups and a parent co-investigator.
  • To compare the differences in parent/family distress at 3- and 30-days between the two models of care, the research team used the state anxiety portion of the State-Trait Anxiety Inventory Form Y.

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    Original Release Date

    2025-07-14

    Version History

    2025-07-14 ICPSR data undergo a confidentiality review and are altered when necessary to limit the risk of disclosure. ICPSR also routinely creates ready-to-go data files along with setups in the major statistical software formats as well as standard codebooks to accompany the data. In addition to these procedures, ICPSR performed the following processing steps for this data collection:

    • Checked for undocumented or out-of-range codes.

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    Notes

    • The public-use data files in this collection are available for access by the general public. Access does not require affiliation with an ICPSR member institution.

    • One or more files in this data collection have special restrictions. Restricted data files are not available for direct download from the website; click on the Restricted Data button to learn more.

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    This study is maintained and distributed by the Patient-Centered Outcomes Data Repository (PCODR). PCODR is the official data repository of the Patient-Centered Outcomes Research Initiative (PCORI).