Enhancing prehospital triage for critically ILL children

The National Institute of Child Health and Human Development awarded Cincinnati Children's Hospital Medical Center $165,032 on September 1, 2026, under the Child Health and Human Development Extramural Research program (CFDA 93.865) to develop the scientific foundation for a prehospital clinical decision support tool that optimizes emergency medical services triage for critically ill and injured children.

The project addresses preventable pediatric mortality by creating evidence-based approaches to help EMS clinicians transport severely ill or injured children to emergency departments best equipped to meet their needs rather than the nearest facility. Work comprises three aims: eliciting how EMS clinicians currently select patient destinations through qualitative interviews and discrete choice experiments; analyzing statewide EMS encounter databases to understand current triage efficiency and identify key drivers; and conducting exploratory cognitive walkthrough analysis. The award runs through August 31, 2031, with place of performance in Cincinnati, Ohio.

Abstract

There are over 2,000 preventable deaths each year related to low-quality emergency care for critically ILL and injured children, representing up to 10% of all pediatric mortality in the united states. Despite national efforts to improve the quality of emergency care across hospitals, pediatric expertise is often centralized in select hospitals, limiting the availability of expert pediatric emergency and subspecialty care. New approaches are needed, therefore, to address this epidemic of preventable mortality and morbidity. Optimizing prehospital triage systems is one approach that may help ensure emergency medical services (EMS) clinicians transport severely ILL or injured children to the emergency department (ED) best-equipped to meet a child's needs, rather than the nearest ED; this approach aligns with national academy of medicine recommendations. Unfortunately, currently available triage tools are insufficient to help EMS clinicians make these decisions, and few data exist to understand how more intentional prehospital triage might work in practice, leaving EMS providers without useful tools to improve triage practices. This project aims to address this GAP by developing the scientific foundation for a prehospital clinical decision support (CDS) tool. In aim 1, we will elicit how EMS clinicians currently select a destination for critically ILL children. First, we will conduct qualitative interviews with EMS clinicians to understand key attributes they consider in selecting a patient destination. Second, this information will inform a discrete choice experiment that measures how these clinicians navigate tradeoffs between different facilities. In aim 2, we will use three statewide databases of EMS encounters to understand the efficiency of current prehospital triage patterns, and to identify key drivers of triage efficiency. In the final exploratory aim, we will use cognitive walkthrough interviews to characterize design requirements for a prehospital CDS triage tool. The principal investigator will be primarily mentored by DR. Maya dewan, an expert in CDS and clinical informatics, and DR. Ellen lipstein, an expert in pediatric decision science. DR. Cole brokamp will provide statistical and methodological expertise, while additional experts will provide subject matter and career development expertise. A targeted career development program will integrate necessary training in clinical informatics, decision science, and leadership skills. Upon completion of the award period, the principal investigator will have the experience, training and skills to independently develop, validate and implement a prehospital CDS tool.