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Self-Assessment of Team Performance using T-NOTECHS in Simulated Pediatric Trauma Resuscitation: Reliability and Correlation with Expert Assessment
MM Wieck MD2, A Rake MD3, RV Burke PhD MPH1,2, LC Young RN BSN CCRN3, TP Chang MD4, E Cleek RN MS CPNP1,2, I Morton RN BSN CPN4, C Goodhue MN RN CPNP1,2, RS Burd MD PhD5, HR Ford MD MHA1,2, JS Upperman MD1,2, and AR Jensen MD MEd1,2. 1Trauma Program, Medicine Children's Hospital, Los Angeles, CA, USA, 2Division of Pediatric Surgery, Medicine Children's Hospital, Los Angeles, CA, USA, 3Division of Anesthesiology and Critical Care Medicine, Medicine Children's Hospital, Los Angeles, CA, USA, 4Division of Emergency and Transport, Medicine Children's Hospital Los Angeles, USC Keck School of Medicine Los Angeles, CA, USA, 5Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC, USA.

Background: Effective teamwork is essential in high acuity pediatric trauma resuscitations, but can be challenging to assess. Team member self-assessment is an attractive option, but is not well studied. The Trauma NOn-TECHnical Skills (T-NOTECHS) instrument has been utilized with expert reviewers, but its utility for self-assessment is not known. The purpose of this study was to assess self-administered T-NOTECHS in pediatric trauma resuscitation by evaluating inter-rater reliability and by comparing self-assessment to live expert assessment.

Methods: Ten in situ simulated resuscitations were conducted with the multidisciplinary trauma team. Resuscitations were evaluated using T-NOTECHS in real time by three experts, and immediately after structured debriefing by each resuscitation team member. Reliability was analyzed with intra-class correlation (ICC). T-NOTECHS scores were compared between expert- and self-assessments.

Results: Composite T-NOTECHS scores were significantly higher for self-assessment compared to experts, with the greatest difference seen in "cooperation and resource management" and "situational awareness /coping with stress" (Table 1). Inter-rater reliability for self-assessment was moderate (ICC=0.60). Correlation between expert- and team self-assessment was poor (Spearman's Rho=0.27, p=0.44).

Conclusions: Self- and expert-assessment may be assessing different constructs potentially related to a lack of team insight into deficiencies in resource management and situational awareness. Expert- and self-assessment should not be used interchangeably until the reasons behind these differences are better understood. Qualitative video-based assessment may elucidate the reasons behind the differing perceptions.

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