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Effect of a checklist on advanced trauma life support task performance during pediatric trauma resuscitation
Deirdre C Kelleher1, Elizabeth A Carter, Lauren J Waterhouse
1The Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC.
Insights
A trauma resuscitation checklist improved adherence to Advanced Trauma Life Support (ATLS) protocols in pediatric trauma care. The checklist increased the frequency and speed of critical ATLS tasks, enhancing patient resuscitation performance.
Area of Science:
- Emergency Medicine
- Pediatric Trauma Care
- Clinical Quality Improvement
Background:
- Advanced Trauma Life Support (ATLS) is crucial for trauma resuscitation outcomes.
- Omissions in ATLS protocol adherence remain a challenge in clinical practice.
Purpose of the Study:
- To evaluate the impact of a trauma resuscitation checklist on the performance of ATLS tasks.
- To assess improvements in completion and timeliness of critical resuscitation steps.
Main Methods:
- Retrospective video review of pediatric trauma resuscitations (n=435) before and after checklist implementation.
- Analysis of ATLS primary and secondary survey task completion and timeliness.
- Statistical control for patient and event-specific characteristics.
Main Results:
- Checklist use significantly increased the frequency of key ATLS primary and secondary survey tasks.
- Vital sign measurements were obtained faster with checklist implementation.
- Overall primary and secondary survey tasks were more likely to be completed and performed faster.
Conclusions:
- Implementing a trauma checklist enhances ATLS task performance in pediatric trauma resuscitation.
- Checklists improve both the frequency and speed of critical survey task completion.
Objectives:
Advanced Trauma Life Support (ATLS) has been shown to improve outcomes related to trauma resuscitation; however, omissions from this protocol persist. The objective of this study was to evaluate the effect of a trauma resuscitation checklist on performance of ATLS tasks.
Methods:
Video recordings of resuscitations of children sustaining blunt or penetrating injuries at a Level I pediatric trauma center were reviewed for completion and timeliness of ATLS primary and secondary survey tasks, with and without checklist use. Patient and resuscitation characteristics were obtained from the trauma registry. Data were collected during two 4-month periods before (n = 222) and after (n = 213) checklist implementation. The checklist contained 50 items and included four sections: prearrival, primary survey, secondary survey, and departure plan.
Results:
Five primary survey ATLS tasks (cervical spine immobilization, oxygen administration, palpating pulses, assessing neurologic status, and exposing the patient) and nine secondary survey ATLS tasks were performed more frequently (p ≤ 0.01 for all) and vital sign measurements were obtained faster (p ≤ 0.01 for all) after the checklist was implemented. When controlling for patient and event-specific characteristics, primary and secondary survey tasks overall were more likely to be completed (odds ratio [OR] = 2.66, primary survey; OR = 2.47, secondary survey; p < 0.001 for both) and primary survey tasks were performed faster (p < 0.001) after the checklist was implemented.
Conclusions:
Implementation of a trauma checklist was associated with greater ATLS task performance and with increased frequency and speed of primary and secondary survey task completion.
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