Validation of a performance assessment scale for simulated intraosseous access

Area of Science:

• Emergency Medicine
• Medical Simulation
• Pediatric Critical Care

Background:

• Intraosseous (IO) access is a critical skill in emergency medicine, particularly for pediatric patients in shock.
• Standardized evaluation tools for IO insertion during simulation are lacking.
• The proximal tibia is a common site for IO access in infants.

Purpose of the Study:

• To develop and validate a reliable scale for assessing intraosseous (IO) needle insertion during simulation.
• To evaluate the performance of emergency physicians using this scale on a pediatric mannequin.
• To determine the success rate and time for IO insertion in a simulated decompensated shock scenario.

Main Methods:

• Development of a 12-item procedural scale for IO insertion into the proximal tibia.
• Evaluation of 31 emergency physicians' performance on a mannequin simulating infant decompensated shock.
• Assessment of interobserver reproducibility and correlation of scale scores with procedure success.

Main Results:

• The IO procedure scale demonstrated high interobserver reproducibility, indicating reliability.
• Procedures evaluated with the scale yielded higher scores for successful insertions (P < .01).
• A 93.5% success rate and a mean placement time of 2 minutes 23 seconds were observed.

Conclusions:

• The developed IO procedure scale is a reliable tool for evaluating manual IO needle insertion in simulation.
• The scale accurately differentiates between successful and unsuccessful IO procedures.
• The scale's potential utility in clinical settings warrants further investigation.