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Updated: May 20, 2026
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
Adherence to ATLS primary and secondary surveys during pediatric trauma resuscitation
Elizabeth A Carter1, Lauren J Waterhouse, Mark L Kovler
1Division of Trauma and Burns, Children's National Medical Center, Washington, DC 20010, United States. ecarter@childrensnational.org
Insights
Factors like burn injuries and overnight shifts delay Advanced Trauma Life Support (ATLS) primary surveys. Penetrating injuries affect secondary surveys. Addressing these can improve pediatric trauma care.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Surgical Protocols
Background:
- Adherence to Advanced Trauma Life Support (ATLS) protocol is crucial for effective management of injured patients.
- Understanding factors influencing ATLS task performance is essential for improving patient outcomes.
Purpose of the Study:
- To identify factors associated with delayed or omitted ATLS primary and secondary survey tasks in pediatric trauma patients.
- To evaluate adherence to ATLS protocols in a level 1 pediatric trauma center.
Main Methods:
- Retrospective review of video-recorded resuscitations of 237 pediatric patients (<18 years old).
- Assessment of completeness and timeliness of ATLS primary and secondary survey tasks.
- Multivariate analyses to determine factors associated with ATLS performance deficits.
Main Results:
- Primary survey tasks were less frequently stated in burn vs. blunt injuries and during overnight shifts.
- Secondary survey tasks were less frequently verbalized in penetrating injuries.
- Primary survey task completion was delayed in burn injuries and for transferred patients; no association with age or ISS.
Conclusions:
- Mechanism of injury (burns, penetrating trauma) and hospital factors (overnight shifts, transfers) significantly impact ATLS primary and secondary survey performance.
- Targeted interventions addressing these specific factors are needed to improve ATLS adherence and reduce errors in pediatric trauma care.
Study Aim:
Adherence to Advanced Trauma Life Support (ATLS) protocol has been associated with improved management of injured patients. The objective of this study is to determine factors associated with delayed and omitted ATLS primary and secondary survey tasks at a level 1 pediatric trauma center.
Methods:
Video recorded resuscitations of 237 injured patients <18 years old obtained over a four month period at our hospital were evaluated to assess completeness and timeliness of essential tasks in the primary and secondary survey of ATLS. Multivariate analyses were performed to identify features associated with decreased ATLS performance.
Results:
Primary survey findings were stated less often in patients with burn injuries compared to those with blunt injuries (RR=1.72; 95% CI: 1.26-2.35) and less often during the overnight shift [11 PM-7 AM] (RR=1.22; 95% CI: 1.02-1.46). Secondary survey findings were verbalized less often in patients with penetrating injures (RR=2.30; 95% CI: 1.06-5.00). Time to statement of primary surveys findings was delayed in patients with burn injuries (HR=0.69; 95% CI: 0.48-0.98) and among those transferred from another hospital. Completeness and timeliness of ATLS task performance were not associated with age or injury severity score.
Conclusions:
Mechanism of injury and hospital factors are associated with incomplete and delayed primary and secondary surveys. Interventions that address deficient ATLS adherence related to these factors may lead to a reduction in errors during this critical period of patient care.
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