Amanda Levin, MD
Assistant Professor
Johns Hopkins University, United States
Disclosure information not submitted.
Title: Pediatric Trauma Care: Strengths and Weaknesses at a Level One Pediatric Trauma Center
Introduction: Pediatric Trauma care is a complex undertaking involving multiple specialties working together to provide optimal care. This study utilizes a consistent evaluation tool to gather data on the performance of pediatric trauma teams at a level one pediatric trauma center in order to inform ongoing and future educational interventions and improve performance of trauma teams in adhering to ATLS ideals.
Methods: Similar to other programs nationally, our pediatric trauma program facilitates and records monthly in situ pediatric trauma simulations and records actual pediatric trauma activations for auditing and performance improvement. Actual traumas are recorded and maintained with approval from the legal department. For this study, each video of a pediatric trauma activation was assessed for teamwork using the Trauma NOTECHS scale (Steinemann et al. 2012), and ATLS compliance by assessing eight items of the primary and secondary survey (Carter et al. 2013). Each trauma activation was reviewed by the same reviewer for consistency.
Results: 29 videos were reviewed including 12 simulated in situ level one trauma activations and 17 actual level one trauma activations. Out of a maximum score of 25, the average total Trauma NOTECHS score for the videos reviewed was 14.1. The Trauma NOTECHS scale has 5 behavioral domains. The domain with the lowest average score (2.2/5) was “Assessment & Decision Making.” The highest average score was for “Situation Awareness/Coping with Stress” (3.2/5). Only 2 teams out of 29 completed all 8 items of the primary survey. The average primary survey score was 5.5/8. The most commonly excluded item was obtaining a temperature (41% completed). The most consistently completed item was breath sounds (93% completed). Only 62% of the teams assigned a Glasgow Coma Score (GCS). The average secondary survey score was 4.1/8. No team completed all 8 items. The most commonly excluded item was an ear exam (25% completed).
Conclusions: Pediatric trauma teams at our institution demonstrated strength in coping with stress in the trauma bay, but weakness in assessment and primary and secondary survey completion. Assignment of a GCS was an additional weakness. The observations from this study will inform educational and quality improvement initiatives within our pediatric trauma program.