Creating a pediatric prehospital destination decision tool using a modified Delphi method

Jennifer F. Anders, Jennifer N. Fishe, Kyle A. Fratta, Jessica H. Katznelson, Matthew J. Levy, Richard Lichenstein, Michael G. Milin, Joelle N. Simpson, Theresa A. Walls, Heather L. Winger

Research output: Contribution to journalArticlepeer-review


Decisions for patient transport by emergency medical services (EMS) are individualized; while established guidelines help direct adult patients to specialty hospitals, no such pediatric equivalents are in wide use. When children are transported to a hospital that cannot provide definitive care, care is delayed and may cause adverse events. Therefore, we created a novel evidencebased decision tool to support EMS destination choice. A multidisciplinary expert panel (EP) of stakeholders reviewed published literature. Four facility capability levels for pediatric care were defined. Using a modified Delphi method, the EP matched specific conditions to a facility pediatriccapability level in a draft tool. The literature review and EP recommendations identified seventeen pediatric medical conditions at risk for secondary transport. In the first voting round, two were rejected, nine met consensus for a specific facility capability level, and six did not reach consensus on the destination facility level. A second round reached consensus on a facility level for the six conditions as well as revision of one previously rejected condition. In the third round, the panel selected a visual display format. Finally, the panel unanimously approved the PDTree. Using a modified Delphi technique, we developed the PDTree EMS destination decision tool by incorporating existing evidence and the expertise of a multidisciplinary panel.

Original languageEnglish (US)
Article number658
Issue number8
StatePublished - Aug 2021


  • Emergency care
  • Emergency medical services (EMS)
  • Pediatrics
  • Prehospital
  • Regionalization
  • Specialty care
  • Transport
  • Triage

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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