Implementation of a Global Pediatric Trauma Course in an Upper Middle-Income Country: A Pilot Study
Abbie Naus1, Madeleine Carroll2, Ayla Gerk3
1Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Lahey Hospital and Medical Center, Beth Israel Lahey, Burlington, MA. Electronic address: https://twitter.com/abbieEnaus.
Insights
The Trauma Resuscitation in Kids (TRIK) course improved pediatric trauma care knowledge and confidence in Brazilian surgeons. This standardized training shows promise for improving outcomes in low- and middle-income countries.
Area of Science:
- Global Health
- Medical Education
- Pediatric Surgery
Background:
- Pediatric trauma causes a significant mortality burden in low- and middle-income countries (LMICs).
- Existing pediatric trauma training is often inaccessible and unstandardized, particularly in LMICs.
- Brazil faces high rates of pediatric trauma mortality, making targeted training crucial.
Purpose of the Study:
- To pilot and assess the feasibility of a globally adapted Trauma Resuscitation in Kids (TRIK) course in Brazil.
- To evaluate the impact of the TRIK course on surgeons' knowledge, skills, and confidence in managing pediatric trauma.
- To identify barriers and inform future implementation of standardized trauma training in LMICs.
Main Methods:
- A 2-day simulation-based global TRIK course was conducted in Belo Horizonte, Brazil.
- Participants (n=21 surgeons) completed pre- and post-course knowledge tests and self-evaluations.
- Simulation performance was assessed using a team performance score, with analysis of performance over time.
Main Results:
- Participants demonstrated significant improvement in post-course knowledge assessment (68% to 76%, P < 0.001).
- Self-reported knowledge and confidence in managing pediatric trauma significantly increased post-course (P < 0.001).
- Average simulation performance scores showed an upward trend from Day 1 (66%) to Day 2 (73%).
Conclusions:
- The global TRIK course effectively enhanced surgeons' knowledge, confidence, and clinical decision-making in pediatric trauma.
- Standardized training like TRIK holds potential for improving pediatric trauma care and outcomes in LMICs.
- Addressing cost, language, and resource barriers is essential for global implementation and improved trauma care equity.
Introduction:
Over 90% of pediatric trauma deaths occur in low- and middle-income countries (LMICs), yet pediatric trauma-focused training remains unstandardized and inaccessible, especially in LMICs. In Brazil, where trauma is the leading cause of death for children over age 1, we piloted the first global adaptation of the Trauma Resuscitation in Kids (TRIK) course and assessed its feasibility.
Methods:
A 2-day simulation-based global TRIK course was hosted in Belo Horizonte in October 2022, led by one Brazilian and four Canadian instructors. The enrollment fee was $200 USD, and course registration sold out in 4 d. We administered a knowledge test before and after the course and a postcourse self-evaluation. We recorded each simulation to assess participants' performance, reflected in a team performance score. Groups received numerical scores for these three areas, which were equally weighted to calculate a final performance score. The scores given by the two evaluators were then averaged. As groups performed the specific simulations in varying orders, the simulations were grouped into four time blocks for analysis of performance over time. Statistical analysis utilized a combination of descriptive analysis, Wilcoxon signed-rank tests, Kruskal-Wallis tests, and Wilcoxon rank-sum tests.
Results:
Twenty-one surgeons (19 pediatric, one trauma, one general) representing four of five regions in Brazil consented to study participation. Women comprised 76% (16/21) of participants. Overall, participants scored higher on the knowledge assessment after the course (68% versus 76%; z = 3.046, P < 0.001). Participants reported improved knowledge for all tested components of trauma management (P < 0.001). The average simulation performance score increased from 66% on day 1% to 73% on day 2, although this increase was not statistically significant. All participants reported they were more confident managing pediatric trauma after the course and would recommend the course to others.
Conclusions:
Completion of global TRIK improved surgeons' confidence, knowledge, and clinical decision-making skills in managing pediatric trauma, suggesting a standardized course may improve pediatric trauma care and outcomes in LMICs. We plan to more closely address cost, language, and resource barriers to implementing protocolized trauma training in LMICs with the aim to improve patient outcomes and equity in trauma care globally.
