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Peer-reviewedCC BY 4.0JAMA Network Open

Telemedicine Consultation for Pediatric Trauma in Community ED Visits and Parent Experience of Care

  • James P. Marcin1
  • Jennifer L. Rosenthal1
  • Daniel J. Tancredi1
  • Tanya Rinderknecht2
  • Michelle Y. Hamline1
  • Holly Leshikar3
  • Marike Zwienenberg4
  • Joseph M. Galante2
  • Jeffrey S. Hoch5
  • Jamie Mouzoon1
  • Sarah C. Haynes1
  • Katherine Rominger1
5 more authors
  • April Sanders1
  • Hadley Sauers-Ford1
  • Raynald Dizon1
  • Jolene L. Lavine1
  • Nathan Kuppermann6
6 affiliations
  1. 1Department of Pediatrics, UC Davis School of Medicine, Sacramento, California
  2. 2Department of Surgery, UC Davis School of Medicine, Sacramento, California
  3. 3Department of Orthopedic Surgery, UC Davis School of Medicine, Sacramento, California
  4. 4Department of Neurosurgery, UC Davis School of Medicine, Sacramento, California
  5. 5Department of Public Health Sciences, UC Davis School of Medicine, Sacramento, California
  6. 6Department of Pediatrics, George Washington University School of Medicine and Health Sciences and Children’s National Hospital, Washington, DC
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Abstract

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

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Cite

BibTeXRIS
BibTeX
@article{marcin2026telemedicine,
  title = {{Telemedicine Consultation for Pediatric Trauma in Community ED Visits and Parent Experience of Care}},
  author = {James P. Marcin and Jennifer L. Rosenthal and Daniel J. Tancredi and Tanya Rinderknecht and Michelle Y. Hamline and Holly Leshikar and Marike Zwienenberg and Joseph M. Galante and Jeffrey S. Hoch and Jamie Mouzoon and Sarah C. Haynes and Katherine Rominger and April Sanders and Hadley Sauers-Ford and Raynald Dizon and Jolene L. Lavine and Nathan Kuppermann},
  journal = {JAMA Network Open},
  year = {2026},
  month = oct,
  doi = {10.1001/jamanetworkopen.2026.36546},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855575},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Telemedicine Consultation for Pediatric Trauma in Community ED Visits and Parent Experience of Care
AU  - James P. Marcin
AU  - Jennifer L. Rosenthal
AU  - Daniel J. Tancredi
AU  - Tanya Rinderknecht
AU  - Michelle Y. Hamline
AU  - Holly Leshikar
AU  - Marike Zwienenberg
AU  - Joseph M. Galante
AU  - Jeffrey S. Hoch
AU  - Jamie Mouzoon
AU  - Sarah C. Haynes
AU  - Katherine Rominger
AU  - April Sanders
AU  - Hadley Sauers-Ford
AU  - Raynald Dizon
AU  - Jolene L. Lavine
AU  - Nathan Kuppermann
PY  - 2026
DA  - 2026/10/21
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.36546
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855575
AB  - 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
SN  - 2574-3805
ER  -