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Simulated pediatric trauma team management: assessment of an educational intervention
Elizabeth A Hunt1, Margaret Heine, Susan M Hohenhaus
1Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. ehunt@jhmi.edu
Insights
An educational intervention significantly improved emergency department (ED) team performance in simulated pediatric trauma resuscitations, enhancing adherence to critical care guidelines for injured children.
Area of Science:
- Emergency Medicine
- Pediatric Trauma Care
- Medical Education
Background:
- Pediatric trauma is a leading cause of mortality in children.
- The quality of initial emergency care significantly impacts outcomes for critically injured children.
- Standardized guidelines exist for pediatric trauma resuscitation, such as Pediatric Advanced Life Support (PALS) and Advanced Trauma Life Support (ATLS).
Purpose of the Study:
- To evaluate the effectiveness of an on-site educational intervention on the performance of emergency department (ED) teams during simulated pediatric trauma resuscitations.
- To assess whether the intervention improves adherence to established pediatric trauma resuscitation protocols.
Main Methods:
- A prospective, pre- and post-intervention study design was employed across a sample of North Carolina EDs.
- Unannounced simulated pediatric trauma resuscitations were conducted before and 6 months after an educational intervention.
- Team performance was measured using a validated clinical assessment tool comprising 44 critical resuscitation tasks.
Main Results:
- All 18 participating EDs completed the study, with excellent interrater reliability (weighted kappa = 0.80).
- The mean number of successfully completed tasks per ED team increased significantly from 17.7 (pre-intervention) to 26.6 (post-intervention) (P < 0.001).
- Performance scores improved for 84% of the 44 assessed tasks, with 25% showing significant improvement.
Conclusions:
- The on-site educational intervention effectively enhanced ED team performance in simulated pediatric trauma resuscitations.
- Post-intervention performance more closely aligned with PALS and ATLS guidelines.
- Further research is warranted to confirm if simulated performance improvements translate to better clinical outcomes for critically injured children.
Objectives:
Trauma is the leading cause of death in children. The quality of initial medical care received by injured children contributes to outcomes. Our objective was to assess effectiveness of an educational intervention on performance of emergency department (ED) teams during simulated pediatric trauma resuscitations.
Methods:
A prospective, preinterventional and postinterventional study was performed on a random, convenience sample of 17% of EDs in North Carolina. An unannounced simulated pediatric trauma resuscitation was conducted at each site, followed by an educational intervention and a second visit 6 months later. The key outcome measure was team performance on a clinical assessment tool previously described that included 44 resuscitation tasks deemed critical to appropriate management of pediatric trauma resuscitation.
Results:
All 18 sites consented and completed the study. Interrater reliability was excellent, weighted kappa = 0.80 (95% confidence interval, 0.76-0.84). After the educational intervention, the mean (+/- SD) number of the 44 tasks passed by each ED team increased from 17.7 +/- 4.3 to 26.6 +/- 5.8 (P < 0.001). At the individual task level, the scores on 37 (84%) of the 44 tasks improved, of which 11 (25%) of the 44 tasks improved significantly.
Conclusions:
This study demonstrated that an on-site educational intervention was effective in improving the performance of ED teams during simulated pediatric trauma resuscitations. Postintervention performance was more consistent with the Pediatric Advanced Life Support and Advanced Trauma Life Support guidelines. Further studies are needed to determine if improved performance in a simulated scenario leads to improved performance and better clinical outcomes of critically injured children.
