The Effect of Family Presence on the Efficiency of Pediatric Trauma Resuscitations
Presented at the Pediatric Academic Societies' 2007 annual meeting, May 2007, Toronto, Ontario, Canada.
Received 29 March 2008; received in revised form 29 August 2008 and 19 September 2008; accepted 1 October 2008. published online 17 November 2008.
Study objective
Family presence has broad professional organizational support and is gaining acceptance. We seek to determine whether family presence prolonged pediatric trauma team resuscitations as measured by time from emergency department arrival to computed tomographic (CT) scan, and to resuscitation completion.
Methods
A prospective trial offered families of pediatric trauma patients family presence on even days and no family presence on odd days. Primary outcome measures were time from arrival to CT scan and to resuscitation completion (laboratory tests, emergency procedures, portable radiographs, and secondary survey). We evaluated the effect of family presence in an adjusted Cox proportional hazards model. Staff and family experiencing a resuscitation with family presence were asked their opinions of that experience.
Results
Of 1,229 pediatric trauma activations, 705 patients were included in the study protocol, 283 with family presence on even days, 422 without family presence on odd days. Median times to CT scan (21 minutes; IQR 16 to 29 minutes) and median resuscitation times (15 minutes; IQR 10 to 20 minutes) were similar with and without family presence. There was no clinically relevant difference in CT time (hazard ratio 1.04; 95% confidence interval [CI] 0.83 to 1.30) or resuscitation time (hazard ratio 0.98; 95% CI 0.83 to 1.15). Families believed that family presence was helpful both to their child and themselves.
Conclusion
This prospective trial shows that family presence does not prolong time to CT imaging or to resuscitation completion for pediatric trauma patients. Family presence does not negatively affect the time efficiency of the pediatric trauma resuscitation.
aDepartment of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT
bDivision of Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT
cDepartment of Surgery, Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT
dTrauma Services, Primary Children's Medical Center, Salt Lake City, UT
eDepartment of Pediatrics and Emergency Medicine, University of Minnesota, Minneapolis, MN
fEmergency Department, Jordan Valley Hospital, Salt Lake City, UT
Address for correspondence: Nanette C. Dudley, MD, PO Box 581289, Salt Lake City, UT 84158; 801-587-7540, fax 801-587-7455
Supervising editors: Michael W. Shannon, MD; Steven M. Green, MD
Author contributions: NCD conceived the study. KLVW provided her knowledge of family presence and the literature to the creation of the family presence program. NCD, KWH, RAF, and ERS solicited the cooperation of staff and the hospital in this endeavor. NCD, KWH, and RAF designed the trial. NCD obtained research funding. KLVW created the education program for staff and educated family support persons and staff about family presence. NCD, KWH, and ERS supervised the conduct of the trial and data collection. KWH managed the data and provided quality control for the trauma registry. RAF provided statistical advice and provided his knowledge of trauma scoring systems to the analysis and article. NCD and AED analyzed the data. AED reviewed the data analysis and performed the regression analysis. NCD drafted the article, and all authors contributed substantially to its revision. NCD takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Supported by a grant from the Primary Children's Medical Center Foundation.
Reprints not available from the authors.
Publication date: Available online November 14, 2008.
ABSTRACT