Abstract
Background
Trauma is the leading cause of mortality among children and adolescents. While often high acuity, these events are lower frequency compared to adult trauma activations. Therefore, it is critical that trauma teams are prepared for the unique elements of pediatric trauma resuscitation. Though the Accreditation Council for Graduate Medical Education (ACGME) requires a minimum of 40 non-operative resuscitations and 20 pediatric surgeries prior to completion of surgical residency, no minimum is placed on pediatric trauma resuscitations. Through the implementation of a multidisciplinary pediatric trauma resuscitation simulation curriculum, we aimed to promote Pediatric Readiness at our institution. By increasing trainee exposure to these low-frequency events, we sought to improve their ability to respond to complex and high-acuity pediatric traumas.
Methods
This pilot curriculum, conducted as monthly one-hour sessions, occurred in the emergency department pediatric resuscitation bays. Clinical scenarios varied each month with increasing complexity throughout the year. The multidisciplinary teams, led by General Surgery and Emergency Medicine residents, were tasked with completing a full assessment during the resuscitation of a pediatric trauma patient, including any indicated bed side procedures. The initial trauma simulation was followed by a debriefing session with supplemental simulation-specific education before roles were redistributed within the teams and the simulation was repeated. During each simulation, Pediatric Surgery and Pediatric Emergency Medicine faculty used a structured observation tool to evaluate overall group performance and to assess indicated elements of the resuscitation surveys that were most frequently performed, delayed, or omitted.
Results
A total of ten simulations were conducted with an average of twelve participants per simulation session. The sessions had an average of four surgical residents, one emergency medicine resident, three emergency room nurses, one respiratory therapist, and two medical students. Between the initial and repeat simulations, teams’ overall completion of indicated elements on the trauma resuscitation observational tool improved by 25% (p < 0.01). The most improvement was seen in the implementation of the first pauses (26% to 72%; p < 0.01) and second pause (35% to 61%; p < 0.01). Significant improvement was also seen between initial and repeat simulations in the management of blood products (p = 0.01) and assessment of the patients’ height and weight (p = 0.01).
Conclusion
Implementation of a pediatric trauma simulation curriculum effectively supplements resident exposure to pediatric trauma resuscitations and leads to improvement in trauma survey completion. Future study is needed to evaluate the long-term impact of simulation-based curricula on clinical outcomes.
Highlights
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Pediatric traumas are a low frequency but often high acuity events.
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Resident exposure to pediatric trauma resuscitation is limited by low frequency.
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Simulation can be used to supplement exposure to pediatric trauma during training.
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Standardized trauma observation tools can be used to assess comprehensiveness of pediatric trauma care.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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EH—Project administration, statistical analysis, manuscript preparation. ST—Conceptualization, project administration, manuscript preparation. Harold Leraas—Conceptualization, project administration, review of manuscript. CV—Conceptualization, project administration, review of manuscript. RO—Project administration, supervision, review of manuscript. EG—Conceptualization, supervision, methodology, review of manuscript. ET—Conceptualization, supervision, methodology, review of manuscript.
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Horne, E.F., Thornton, S.W., Leraas, H.J. et al. Multidisciplinary pediatric trauma simulation curriculum in conjunction with a trauma resuscitation cognitive aid improves resident performance. Global Surg Educ 3, 16 (2024). https://doi.org/10.1007/s44186-023-00204-7
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DOI: https://doi.org/10.1007/s44186-023-00204-7