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Trauma Simulation

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By Roberta Miller, MSN
Cooks Children's Medical Center

CITATION: Khobrani, A., Patel, N. H., George, R. L., McNinch, N. L., & Ahmed, R. A. (2018). Pediatric Trauma Boot Camp: A Simulation Curriculum and Pilot Study. Emergency Medicine International, 2018, 7982315. http://doi.org/10.1155/2018/7982315

TOPIC: Trauma Simulation

Review: (R. Miller) Worldwide, trauma tops the list of leading causes of morbidity and mortality for infants and children, and trauma education is commonly reported to be deficient in emergency medicine and trauma training. Pediatric trauma management is complex requiring the coordinated efforts of a multidisciplinary health care team. Simulation based learning increases knowledge, skill and confidence in care. The study explores the creation and implementation of a simulation-based training to improve skills and increase confidence in the care provided to pediatric trauma patients.

Title: Pediatric Trauma Boot Camp: A Simulation Curriculum and Pilot Study.

Emergency Medicine International.

Authors: Ahmad Khobrani, Nirali H. Patel, Richard L. George, Neil L. McNinch, and Rami A. Ahmed

Author Affiliations: Department of Pediatric Emergency Medicine, King Faisal Medical City Southern Regions, Ministry of Health, Abha, Saudi Arabia

Summa Health System, Akron, OH, USA

Department of Pediatric Emergency Medicine, Akron Children's Hospital, Akron, OH, USA

Division of Trauma, Department of Surgery, Summa Health, Akron, OH, USA

Northeast Ohio Medical University, Akron, OH, USA

Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA

Department of Medical Education, Summa Health, Akron, OH, USA

Downloaded From: Emergency Medicine International (January 2018) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817262/

WHY THIS ARTICLE IS RELEVANT OR IMPORTANT: A significant portion of errors resulting in death in pediatric trauma patients occur during the initial evaluation and management. Literature supports trauma care is improved with frequency of practice and increased education. However, major pediatric trauma occurs at a much lower rate than adult trauma. Trauma education using simulation is essential to improving effective leadership, teamwork, and communication for the trauma team. A pediatric trauma care course using simulation was developed using a team approach to pediatric trauma management. A two-day course resulted in increased confidence, knowledge of pediatric trauma management, and performance in a simulated environment.

VERY BRIEF REVIEW: One of the most commonly recognized areas for improvement in pediatric medicine training is trauma education. The study used a curriculum focused on leadership, effective communication, and management of pediatric trauma patients. The study describes the development of a boot camp in for assessing basic knowledge, level of confidence, teamwork, and communication skills. The study was performed at on offsite simulation lab of a tertiary-care, American College of Surgeons verified Level I Trauma center, university affiliated, teaching hospital in February of 2017. High-fidelity pediatric simulators were used for all simulations. A two-day boot camp curriculum was designed for pediatric emergency medicine fellows and emergency medicine residents on the management of traumatic injuries in pediatric patients. The curriculum consisted of a two-day, 10-hour total experience, which included a pretest confidence survey, a pretest cognitive multiple-choice questionnaire, two pretraining simulation scenarios, six additional formative simulation scenarios, a posttest confidence survey, a posttest cognitive multiple-choice questionnaire, and two final testing simulation scenarios. The boot camp was well received and attended. Positive feedback included life-like simulation scenarios including a high-pressure environment, multidisciplinary debriefings, and succinct reviews of critical management points.

Background: Trauma is a leading cause of morbidity and mortality in infants and children. Pediatric trauma management requires the rapid coordinated efforts of a multidisciplinary health care team. Pediatric patients have several different anatomic and physiologic features from adult patients requiring expertise for successful resuscitation and management. Trauma education is one of the most commonly reported deficiencies in pediatric emergency medicine training despite most pediatric emergency medicine (PEM) fellows receiving Pediatric Advance Life Support (PALS) and Advance Trauma Life Support (ATLS) at the beginning of their training.

Methods: This was a pilot, prospective, single cohort, exploratory, observational study utilizing survey methodology and a convenience sample. The boot camp curriculum included a pretest confidence survey, a pretest cognitive multiple-choice questionnaire, two pretraining simulation scenarios, six additional formative simulation scenarios, a posttest confidence survey, a posttest cognitive multiple-choice questionnaire, and two final testing simulation scenarios. The preintervention evaluation consisted of a confidence survey. All pretraining and final testing simulated cases were recorded for evaluation and review. Participants underwent an identical confidence survey and multiple-choice test at the completion of curriculum and simulation cases. Examination of data included summary statistics and evaluation of distribution for continuous data along with calculations of frequencies and percentages for categorical data. Testing for pre/post differences in test scores was done utilizing the paired t-test. Testing for pre/post differences in confidence items was done utilizing the Wilcoxon Signed Rank Test. Descriptive statistics were completed for the pre/post NOTECHS evaluations.

Results: The Paired t-Test provided evidence of a significant difference between (post minus pre) test scores (p value ≤ 0.01), with the mean paired difference (95% CI) being 13.8% (9.218.5). The mean (SD) pretest score was 52.3% (10), compared to 66.2% (8.7). The Wilcoxon Signed Rank Test was used to compare the (post minus pre) change in responses to Likert Type items, for questions (1) through (15). The median change for each significant item was equal to an increase of 1-2 on the Likert Scale used for each question, with corresponding interquartile ranges of (0-1) or (02). All changes were positive, indicating higher agreement (confidence) on the postintervention survey items. The NOTECHS scores were evaluated descriptively for each team and case as the percentage difference in average rating by domain (leadership, cooperation, communication, assessment, and situation). All percentage changes calculated represented increases from pre-to post evaluation. The smallest and largest changes in any domain also represented the greatest variability and improvement in an individual domain.

Conclusion: A curriculum including simulation for management of the pediatric trauma patient resulted in increased self-confidence, knowledge of pediatric trauma management and improved performance. The pilot study offers a unique framework to apply to training programs as a foundation for effective leadership, communication and teamwork training for the management of pediatric trauma.

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