Pediatric Urgent Care Center Management of Traumatic Injuries in Infants and Children: Adherence with Evidence-based Practice Guidelines

Background: Urgent Care Centers (UCCs) fill a gap in care between the medical home and the emergency department (ED). Life-threatening emergencies that require immediate recognition, stabilization, and transfer may present to UCCs. Published studies have shown that patients with minor injuries are often referred or transferred from general UCCs to EDs rather than receiving evidence-based care and being discharged home. Pediatric patients seen in general UCCs have an even higher rate of ED transfer for minor injuries than adults. Pediatric UCC clinician management and disposition in common pediatric trauma cases has not previously been studied. Pediatric UCCs are typically staffed with pediatricians and advance practice providers (APPs) who have specific pediatric training which may make management and disposition of common pediatric minor trauma in this setting distinct from general UCCs. The aims of this study were to determine pediatric urgent care clinician adherence to evidence-based practice guidelines in the management of pediatric trauma and to evaluate PUC emergency preparedness.

Methods: A questionnaire covering acute management of 15 pediatric traumatic injuries, awareness of the Stop the Bleed® initiative, and presence of emergency equipment/medications was electronically distributed to members of the Society for Pediatric Urgent Care. Clinician management decisions were evaluated against evidence-based practice guidelines.

Results: Eighty-three completed questionnaires were returned (25% response rate). Fifty-three physician and 25 advanced-practice provider (APP) questionnaires were analyzed for management and disposition decisions. Most respondents were adherent to evidence-based practice guidelines in the following scenarios: cervical spine injury; head injury without neurologic symptoms; blunt abdominal injury; laceration without bleeding, foreign body, or signs of infection; first degree burn; second degree burns with < 10% total body surface area; animal bite with and without probable tenosynovitis; and orthopedic fractures. Fewer respondents were adherent in the following scenarios: head injury with altered mental status (adherence: physicians 64%, APPs 44%) and laceration with foreign body and persistent hemorrhage (adherence: physicians 52%, APPs 41%). Most respondents (56%) were unaware of Stop the Bleed® and only 48% reported having bleeding control kits/tourniquets at their urgent care.

Conclusion: Providers in our sample demonstrated adherence to pediatric trauma evidence-based practice guidelines. Increased education in hemorrhagic traumatic injuries, awareness of Stop the Bleed®, and presence of certain equipment/medications would further improve emergency preparedness.