David Häske1,2, Zeno Gross3, Ulrich Atzbach4, Michael Bernhard5, Andreas Gather3, Jochen Hoedtke6,7, Björn Hossfeld8, Stephan Schele9,10, Matthias Münzberg11,12. 1. Center of Public Health and Health Services Research, University Hospital Tübingen, Tübingen, Germany. 2. Emergency Medical Service, German Red Cross, Reutlingen, Germany. 3. Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, University Hospital Heidelberg, Ludwigshafen, Germany. 4. PHTLS, Academy of the German Association of Emergency Medical Services, Lübeck, Germany. 5. Emergency Department, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany. 6. Asklepios Klinik Barmbek, Department of Anesthesiology, Intensive and Emergency Medicine, Pain Therapy, Hamburg, Germany. 7. Trauma Management Network, Training Center Schlump, Hamburg, Germany. 8. Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, HEMS 'Christoph 22', Federal Armed Forces Hospital Ulm, Ulm, Germany. 9. Department of Anesthesiology, Intensive and Emergency Medicine, Klinikverbund Allgäu gGmbH, Immenstadt, Germany. 10. ITLS-International Trauma Life Support Germany e.V., Mölln, Germany. 11. Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, University Hospital Heidelberg, Ludwigshafen, Germany. matthias.muenzberg@bgkliniken-lu-tue.de. 12. Department of Rescue and Emergency Medicine, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany. matthias.muenzberg@bgkliniken-lu-tue.de.
Abstract
PURPOSE: Training programs help establish evidence-based knowledge in prehospital emergency care. This study aimed to compare manual statements from prehospital trauma training programs and evidence-based guidelines on treatment of patients with severe and multiple injuries. METHODS: A systematic comparison with the primary endpoint of the highest grades of recommendation (GoR A, "must") of the current version of the German guidelines and recent recommendations of the prehospital trauma training programs International Trauma Life Support (ITLS), Prehospital Trauma Life Support (PHTLS), and Traumamanagement® (TM) based on their official textbooks was done. The recommendations were categorized as agreement or minor or major variation. The comparison was made using a rating system by experts who were blinded to the training programs. If the consensus strength of the experts was < 75%, affected statements were finalized in a Delphi procedure. RESULTS: Overall, 92 statements were compared. Fleiss-kappa of the first rating was 0.385 (p < 0.001, 95% CI: 0.376-0.393). Finally, comparable recommendations of the guideline with the training programs in principle agree with the statement of the guidelines were > 90% for all programs. The agreement with GoR A recommendations and each course program were 33.9%, 30.6%, and 35.5% (ITLS, PHTLS, and TM, respectively), p = 0.715. CONCLUSIONS: Despite small differences, the training programs showed high degrees of compliance with the guidelines and international agreement with some minor differences. Furthermore, the results did not allow any conclusions regarding the quality of the courses, the didactic methodology, and local adaptability. The practical implementation of the courses is probably even higher and closer to the guidelines.
PURPOSE: Training programs help establish evidence-based knowledge in prehospital emergency care. This study aimed to compare manual statements from prehospital trauma training programs and evidence-based guidelines on treatment of patients with severe and multiple injuries. METHODS: A systematic comparison with the primary endpoint of the highest grades of recommendation (GoR A, "must") of the current version of the German guidelines and recent recommendations of the prehospital trauma training programs International Trauma Life Support (ITLS), Prehospital Trauma Life Support (PHTLS), and Traumamanagement® (TM) based on their official textbooks was done. The recommendations were categorized as agreement or minor or major variation. The comparison was made using a rating system by experts who were blinded to the training programs. If the consensus strength of the experts was < 75%, affected statements were finalized in a Delphi procedure. RESULTS: Overall, 92 statements were compared. Fleiss-kappa of the first rating was 0.385 (p < 0.001, 95% CI: 0.376-0.393). Finally, comparable recommendations of the guideline with the training programs in principle agree with the statement of the guidelines were > 90% for all programs. The agreement with GoR A recommendations and each course program were 33.9%, 30.6%, and 35.5% (ITLS, PHTLS, and TM, respectively), p = 0.715. CONCLUSIONS: Despite small differences, the training programs showed high degrees of compliance with the guidelines and international agreement with some minor differences. Furthermore, the results did not allow any conclusions regarding the quality of the courses, the didactic methodology, and local adaptability. The practical implementation of the courses is probably even higher and closer to the guidelines.
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