Pediatric Trauma Society

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The Association between Pre-arrival Notification Time and Adherence to ATLS Protocol
Omar Z Ahmed1, Sen Yang2, Richard A Farneth1, Aleksandra Sarcevic3, Ivan Marsic2, Randall S Burd1
1Children's National Medical Center, Washington, DC;2Rutgers University, Piscataway, NJ;3Drexel University, Philadelphia, PA

Pre-arrival notification facilitates preparation of personnel, equipment and other resources needed for injured patients. Our purpose was to determine the impact of pre-arrival notification on adherence to the ATLS protocol.
Ninety-five pediatric trauma resuscitations from 2014-2016 were analyzed by video review to determine ATLS activities performed. Using an expert model of trauma resuscitation based on ATLS, fitness scores were calculated that represented model adherence, ranging from 0 (non-compliant) to 1 (completely compliant). Multivariate regression was used to evaluate the association between fitness and the length of pre-arrival notification as well as the percentage of team members present at patient arrival.
The average fitness for overall resuscitations was 0.89 0.07, with similar fitness values being observed for the primary and secondary surveys (0.91 0.14 and 0.89 0.08, respectively). Pre-arrival notification ranged from 67.3 minutes before to 4.8 minutes after patient arrival. Longer pre-arrival notification time was associated with improved completion of pre-arrival tasks, overall resuscitation performance and secondary survey performance. The positive effect on overall and secondary survey fitness was not observed when notification time was <5 minutes and <10 minutes, respectively. A higher percentage of team members present when the patient arrived was associated with more completed pre-arrival tasks and higher primary survey compliance.
Adequate pre-arrival notification and increased team member presence at the time of patient arrival has a significant association with ATLS adherence.

Variable Effect on Adherence to ATLS Expert Model (Measured by Fitness)
Pre-arrival Tasks (%)Overall Resuscitation FitnessPrimary Survey FitnessSecondary Survey Fitness
VariableEstimate (95% CI)Estimate (95% CI)Estimate (95% CI)Estimate (95% CI)
Length of pre-arrival notification0.006* (1.000, 1.012)0.002* (1.000, 1.004)0.001 (0.998, 1.004)0.002* (1.000, 1.004)
% of team members present0.649^ (1.492, 2.453)0.019 (0.963, 1.078)0.126* (1.023, 1.257)-0.001 (0.939, 1.064)
adjusted for age, injury severity, injury type, body region injured, time of day and day of week; *p-value <0.05; ^p-value <0.001

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