Lilly Bayouth1, Sarah Ashley2, Jackie Brady3, Bryan Lake4, Morgan Keeter5, David Schiller6, Walter C Robey7, Stephen Charles8, Kari M Beasley9, Eric A Toschlog10, Shannon W Longshore11. 1. Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, USA. Electronic address: bayouthl14@ecu.edu. 2. Department of Emergency Medicine, Brody School of Medicine at East Carolina University, 600 Moye Blvd Greenville, NC, USA. Electronic address: ashleysa14@ecu.edu. 3. Department of Trauma, Vidant Medical Center, 2100 Stantonsburg Road 2ED, Greenville, NC, USA. Electronic address: Jaqueline.brady@vidanthealth.com. 4. Department of Trauma, Vidant Medical Center, 2100 Stantonsburg Road 2ED, Greenville, NC, USA. Electronic address: james.lake@vidanthealth.com. 5. Department of Trauma, Vidant Medical Center, 2100 Stantonsburg Road 2ED, Greenville, NC, USA. Electronic address: morgan.keeter@vidanthealth.com. 6. Clinical Simulation Program, Brody School of Medicine at East Carolina University, BSOM 1L-28, Greenville, NC, USA. Electronic address: schillerd15@ecu.edu. 7. Clinical Simulation Program, Brody School of Medicine at East Carolina University, BSOM 1L-28, Greenville, NC, USA. Electronic address: robeyw@ecu.edu. 8. Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, USA. Electronic address: charless16@ecu.edu. 9. Vidant Health Center for Research and Grants, Vidant Medical Center, Greenville, NC. Electronic address: Kari.Beasley@vidanthealth.com. 10. Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, USA. Electronic address: toschloge@ecu.edu. 11. Division of Pediatric Surgery, Brody School of Medicine at East Carolina University, 600 Moye Blvd MA, 207, Greenville, NC, USA. Electronic address: longshores@ecu.edu.
Abstract
BACKGROUND: Outcome disparities between urban and rural pediatric trauma patients persist, despite regionalization of trauma systems. Rural patients are initially transported to the nearest emergency department (ED), where pediatric care is infrequent. We aim to identify educational intervention targets and increase provider experience via pediatric trauma simulation. METHODS: Prospective study of simulation-based pediatric trauma resuscitation was performed at three community EDs. Level one trauma center providers facilitated simulations, providing educational feedback. Provider performance comfort and skill with tasks essential to initial trauma care were assessed, comparing pre-/postsimulations. Primary outcomes were: 1) improved comfort performing skills, and 2) team performance during resuscitation. RESULTS: Provider comfort with the following improved (p-values <0.05): infant airway, infant IV access, blood administration, infant C-spine immobilization, chest tube placement, obtaining radiographic images, initiating transport, and Broselow tape use. The proportion of tasks needing improvement decreased: 42% to 27% (p-value=0.001). Most common deficiencies were: failure to obtain additional history (75%), beginning secondary survey (58.33%), log rolling/examining the back (66.67%), calling for transport (50%), calculating medication dosages (50%). CONCLUSIONS: Simulation-based education improves provider comfort and performance. Comparison of patient outcomes to evaluate improvement in pediatric trauma care is warranted. LEVEL OF EVIDENCE RATING: IV.
BACKGROUND: Outcome disparities between urban and rural pediatric traumapatients persist, despite regionalization of trauma systems. Rural patients are initially transported to the nearest emergency department (ED), where pediatric care is infrequent. We aim to identify educational intervention targets and increase provider experience via pediatric trauma simulation. METHODS: Prospective study of simulation-based pediatric trauma resuscitation was performed at three community EDs. Level one trauma center providers facilitated simulations, providing educational feedback. Provider performance comfort and skill with tasks essential to initial trauma care were assessed, comparing pre-/postsimulations. Primary outcomes were: 1) improved comfort performing skills, and 2) team performance during resuscitation. RESULTS: Provider comfort with the following improved (p-values <0.05): infant airway, infant IV access, blood administration, infant C-spine immobilization, chest tube placement, obtaining radiographic images, initiating transport, and Broselow tape use. The proportion of tasks needing improvement decreased: 42% to 27% (p-value=0.001). Most common deficiencies were: failure to obtain additional history (75%), beginning secondary survey (58.33%), log rolling/examining the back (66.67%), calling for transport (50%), calculating medication dosages (50%). CONCLUSIONS: Simulation-based education improves provider comfort and performance. Comparison of patient outcomes to evaluate improvement in pediatric trauma care is warranted. LEVEL OF EVIDENCE RATING: IV.
Authors: Fabio Botelho; Paul Truche; David P Mooney; Luke Caddell; Kathrin Zimmerman; Lina Roa; Nivaldo Alonso; Alexis Bowder; Domingos Drumond; Simone de Campos Vieira Abib Journal: Trauma Surg Acute Care Open Date: 2020-07-21