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The ABCDE approach: Evaluation of adherence in a low-income country
Julia Adam Bashir Koko1, Omer Safieldin Altaher Mohamed2, Bashir Adam Bashir Koko3
1Faculty of Medicine, University of Medical Sciences and Technology (UMST), Khartoum, Sudan.
Insights
Trauma teams show low adherence to the Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach, with overcrowding and facilities being key barriers. Clinical experience was a facilitator, but adherence remained low at 37.9%.
Area of Science:
- Emergency Medicine
- Trauma Care
- Clinical Management
Background:
- The "Airway, Breathing, Circulation, Disability and Exposure" (ABCDE) approach is critical for early trauma patient management.
- Limited knowledge exists regarding adherence to the ABCDE approach in clinical practice.
- Assessing adherence and influencing factors is crucial for improving trauma care outcomes.
Purpose of the Study:
- To evaluate the adherence of trauma team members to the ABCDE approach.
- To identify factors affecting adherence to the ABCDE protocol in major trauma cases.
- To inform strategies for enhancing trauma resuscitation effectiveness.
Main Methods:
- A cross-sectional, hospital-based study was conducted in major governmental hospitals in Khartoum.
- Data collection involved direct observation using a checklist and a self-administered questionnaire.
- Fifty major trauma resuscitations and 158 medical staff were included in the study.
Main Results:
- Mean adherence to the ABCDE approach was 37.9%, with ACB being the most common alternative sequence.
- No significant relationship was found between adherence and patient or staff-related factors.
- Overcrowding and inadequate facilities were primary obstacles, while clinical experience was a facilitator.
Conclusions:
- Adherence to the ABCDE approach in trauma care was low, despite rapid initiation.
- Facility and population-based factors significantly impacted adherence rates.
- Recommendations include enhanced training, guideline implementation, and improved trauma room resources.
Background:
Early recognition and initial treatment of trauma patients prevents deterioration and buys time for making a definitive diagnosis. The "Airway, Breathing, Circulation, Disability and Exposure" (ABCDE) approach should be used whenever an injury is suspected. It provides quick identification and management of life-threatening problems. Still, there is limited knowledge regarding adherence to the ABCDE approach. This research aims to assess the adherence of the trauma team members to the ABCDE approach in the management of major trauma patients and the factors affecting it.
Method:
The study is a cross-sectional hospital-based study conducted in the trauma and resuscitation rooms of major governmental hospitals in Khartoum in the period from Jan.30, 2022, to Mar.29, 2022. It was done among the medical staff dealing with major trauma cases. Data were collected by observation using a modified standardized checklist for assessing the ABCDE approach and via a self-administered questionnaire for identifying the factors affecting adherence. Total coverage of all major trauma cases resuscitation (n = 50) was done. Also, a sample size of 158 medical staff was covered for the questionnaire. The data was analyzed in Statistical Package for the Social Science (SPSS) V.23.
Results:
The mean percentage of adherence to the ABCDE approach was 37.9 % (SD 15.44). When the ABCDE sequence was not followed, the ACB was the commonest sequence. Also, adherence had no significant relation with any patient or staff-related factor. The main present obstacles to adherence to the ABCDE approach were overcrowding in the room and unprepared facilities. While the major present facilitator was the clinical experience.
Conclusion:
The adherence rate was low, but initiation of the ABCDE approach was rapid. The factors participating in low adherence rates were usually facility or population-based factors. We recommend further studies, further training and embedment of guidelines, and the provision of larger trauma rooms with adequate supplies.
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