Clinical Scorecard: Supporting Families of Injured Children Before Interhospital Transfer Requires More Than Telemedicine

At a Glance

Key Highlights

• In a study of 595 injured children, telephone and telemedicine consultation groups did not differ significantly in the reported primary outcomes, including transfer frequency and parental distress.
• Ratings of the emergency department discharge and/or transfer experience favored telemedicine on one subscale.
• Many transfers may be clinically necessary; lower transfer frequency alone does not establish better care.
• Safety and outcomes data are needed to assess strategies intended to prevent transfers, including their effects on costs and resource use.
• Families of children who died within 3 days were excluded from the study, leaving their perspectives unrepresented.

Guideline-Based Recommendations

Diagnosis

• The article does not provide diagnostic criteria or recommendations for pediatric trauma.

Management

• Consider family support and communication as distinct from clinically focused outcomes such as transfer appropriateness and safety.
• Evaluate telemedicine, clinician-to-clinician teleconsultation, decision support, and transfer as approaches to connecting children with pediatric expertise; the article does not establish one as optimal.

Monitoring & Follow-up

• Assess transfer strategies using safety and outcomes data, as well as costs and resource utilization.
• Evaluate both clinically focused outcomes and family-centered outcomes, including experience and distress.

Risks

• Reducing transfer frequency may not be preferable when transfers are clinically necessary.
• Families with social needs, including transportation insecurity, may require additional resources when care is provided at a more distant center.
• Study findings do not represent families of children who died within 3 days, because those patients were excluded.

Patient & Prescribing Data

The discussed study enrolled 595 injured children receiving remote consultation; children who died within 3 days were excluded.

The article reports no medication or prescribing data. In the study, telephone and telemedicine groups had no significant differences in primary outcomes; one subscale rating the ED discharge and/or transfer experience favored telemedicine.

Clinical Best Practices

• Do not treat a lower transfer rate as an optimal outcome without considering clinical necessity, safety, and outcomes.
• Address family communication and experience alongside transfer appropriateness and safety.
• Consider that neighborhood-level measures may not reflect an individual family's circumstances or needs.
• Include targeted work to understand the perspectives of families of the most severely injured children.

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