Between paradigms: Comparing experiences for adolescents treated at pediatric and adult trauma centres.

INTRODUCTION: Injured adolescents may be treated at pediatric trauma centres (PTCs) or adult trauma centres (ATCs). Patient and parent experiences are an integral component of high-quality health care and can influence patient clinical trajectory. Despite this knowledge, there is little research on differences between PTCs and ATCs with respect to patient and caregiver-reported experience. We sought to identify differences in patient and parent-reported experiences between the regional PTC and ATC using a recently developed Patient and Parent-Reported Experience Measure. METHODS: We prospectively enrolled patients (caregivers) aged 15-17 (inclusive), admitted to the local PTC and ATC for injury management (01/01/2020 - 31/05/2021) We provided a survey 8-weeks post-discharge to query acute care and follow-up experience. Patient and parent experiences were compared between the PTC and ATC using descriptive statistics, chi-square tests for categorical and independent t-tests for continuous variables. RESULTS: We identified 90 patients for inclusion (51 PTC, and 39 ATC). From this population, we had 77 surveys (32 patient and 35 caregiver) completed at the PTC, and 41 (20 patient and 21 caregiver) at the ATC. ATC patients tended to be more severely injured. We identified few differences in reported experience on the patient measure but identified lower ratings from caregivers of adolescents treated in ATCs for the domains of information and communication, follow-up care, and overall hospital scores. Patients and parents reported poorer family accommodation at the ATC. CONCLUSION: Patient experiences were similar between centres. However, caregivers report poorer experiences at the ATC in several domains. These differences are multifaceted, and may reflect differing patient volumes, effects of COVID-19, and healthcare paradigms. However, further work should target information and communication improvement in adult paradigms given its impact on other domains of care.

Development of the quality of teen trauma acute care patient and parent-reported experience measure.

OBJECTIVE: Patient-Reported Experience Measures (PREMs) provide valuable patient feedback on quality of care and have been associated with clinical outcomes. We aimed to test the reliability of a modified adult trauma care PREM instrument delivered to adolescents admitted to hospital for traumatic injuries, and their parents. Modifications included addition of questions reflecting teen-focused constructs on education supports, social network maintenance and family accommodation. RESULTS: Forty adolescent patients and 40 parents participated. Test-retest reliability was assessed using Cohen's kappa, weighted kappa, and percent agreement between responses. Directionality of changed responses was noted. Most of the study ran during the COVID-19 pandemic. We established good reliability of questions related to in-hospital and post-discharge communication, clinical and ancillary care and family accommodation. We identified poorer reliability among constructs reflecting experiences that varied from the norm during the pandemic, which included "maintenance of social networks", "education supports", "scheduling clinical follow-ups" and "post-discharge supports". Parents, but not patients, demonstrated more directionality of change of responses by responding with more negative in-hospital and more positive post-discharge experiences over time between the test and retest periods, suggesting risk of recall bias. Situational factors due to the COVID-19 pandemic and potential risks of recall bias may have limited the reliability of some parts of the survey.

A novel virtual helmet fit assessment for ice hockey and ringette players amidst the COVID-19 pandemic

BackgroundProper helmet fit is an important consideration for preventing head injuries, including concussions, in helmeted sports like youth ice hockey and ringette. Helmet fit assessments are typically completed in-person;however, this was not possible given COVID-19 restrictions. Thus, alternative considerations for virtual assessments were required.ObjectiveTo examine the feasibility and inter-rater reliability of virtual ice hockey and ringette helmet fit assessments.DesignCross-sectional.SettingCalgary, Canada.ParticipantsElite/upper division youth (ages 13–18) ice hockey (n=31 males) and ringette (n=30 females) players.Assessment of Risk FactorsStandardized ice hockey/ringette helmet fit criteria were developed and reliable for in-person assessments. Criteria were adapted for virtual delivery to participants over ZOOM video platform individually by two trained assessors per sport.Main Outcome MeasurementsTwelve helmet fit criteria scored as yes/proper fit or no/poor fit were used to assess helmet shell fit (e.g., helmet fits snug, doesn’t cover eyes), positioning (e.g., helmet is 1–2 finger widths above eyebrows, covers base of skull), facemask fit (e.g., chin piece fits, facemask does not move left/right), and others. Percent agreement (PA) between raters was used to describe inter-rater reliability, and each rater documented barriers for completing the assessments virtually.ResultsAcceptable PA (>80%) was demonstrated for 8/12 criterion for ice hockey and 9/12 for ringette. Below acceptable agreement was found for all four criterion assessing the helmet facemask fit (PA range: 48%-74%) in ice hockey players and criteria for the chin straps fit (PA=66%), helmet positioning (PA=73%), and facemask fit (PA=63%) in ringette players. Common barriers were related to technology (e.g., audio/video quality) and environment (e.g., noisy, lighting).ConclusionsVirtual helmet fit assessments are feasible and reliable for most criteria, with more training required for criteria below acceptable agreement. Virtual assessments provides another option for assessing helmet fit for concussion prevention in helmeted sports.