JAMA: Telemedicine Consultation for Pediatric Trauma in Community ED Visits and Parent Experience of Care: A Stepped-Wedge Cluster-Randomized Clinical Trial

Importance: Telephone consultations for acutely injured children receiving care in emergency departments (EDs) in nonpediatric trauma centers frequently exclude direct communication and informed decision-making with parents. The use of telemedicine to facilitate real-time expert consultation and parental communication with pediatric trauma specialists is underexplored and may improve family experience and support clinical decision-making.

Objective: To examine the impact of telemedicine on parent experience of care, parent distress, and transfer frequency for acutely injured children presenting to EDs in nonpediatric trauma centers.

Design, setting, and participants: This stepped-wedge cluster-randomized clinical trial recruited patients between November 30, 2020, and November 27, 2022. Participants included families of children younger than 18 years with acute physical trauma presenting to 1 of 10 nonpediatric trauma centers in northern California. Analyses were conducted between June 2023 and March 2026.

Interventions: EDs were randomized to use telemedicine following a standard telephone consultation or the standard of care (telephone consultation only) when consulting with pediatric trauma physicians.

Main outcomes and measures: Primary outcomes were parent experience of care and parent distress measured 3 days or more following the child's injury. Experience of care was measured using ED Consumer Assessment of Healthcare Providers and Systems (CAHPS) questions. Distress was measured using the State-Trait Anxiety Inventory Form Y survey. Modified intention-to-treat analyses were performed to evaluate outcomes.

Results: The study included 595 children with acute physical trauma with a mean (SD) age of 7.6 (5.1) years, of whom 369 (62.0%) were assigned to telemedicine and 226 (38.0%) to standard of care. Summary scores for parent experience of care 3 days post injury were similar between cohorts (adjusted mean difference [AMD], 0.041 [95% CI, -0.008 to 0.090; P = .10]), as were parent distress summary scores (AMD, -0.031 [95% CI, -0.297 to 0.235; P = .82]). The adjusted odds ratio for transfer of patients assigned to telemedicine was 0.59 (95% CI, 0.16 to 2.16; P = .43). Subscale analyses found significantly higher parental ED discharge and/or transfer experience ratings for patients assigned to telemedicine (AMD, 0.104 [95% CI, 0.023 to 0.186; P = .01]).

Conclusions and relevance: In this randomized clinical trial, telemedicine consultations did not differ statistically significantly from standard care with respect to parent experience of care, distress, and transfer rates. Subscale analyses suggested a potential improvement with telemedicine consultations in parent experience related to ED discharge and interfacility transfers, highlighting a potential benefit in communication and preparation during care transitions.

Trial registration: ClinicalTrials.gov Identifier: NCT04469036.