Skip to main content

Advertisement

SpringerLink
Log in

Introducing the Safety Threats and Adverse events in Trauma (STAT) taxonomy: standardized classification system for evaluating safety during trauma resuscitation

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Adverse events (AEs) during trauma resuscitation are common and heterogeneity in reporting limits comparisons between hospitals and systems. A recent modified Delphi study established a taxonomy of AEs that occur during trauma resuscitation. This tool was further refined to yield the Safety Threats and Adverse events in Trauma (STAT) taxonomy. The objective of this study was to evaluate the inter-rater reliability of the STAT taxonomy using in-situ simulation resuscitations.

Methods

Two reviewers utilized the STAT taxonomy to score 12 in-situ simulated trauma resuscitations. AEs were reported for each simulation and timestamped in the case of multiple occurrences of a single AE. Inter-rater reliability was assessed using Gwet’s AC1.

Results

The agreement on all AEs between reviewers was 90.1% (973/1080). The Gwet’s AC1 across AE categories were: EMS handover (median 0.72, IQR [0.54, 0.82]), airway and breathing (median 0.91, IQR [0.60, 1.0]), circulation (median 0.91, IQR [0.72, 1.0]), assessment of injuries (median 0.80, IQR [0.24, 0.91]), management of injuries (median 1.00, IQR [1.00, 1.00]), procedure related (median 1.00, IQR [81, 1.00]), patient monitoring and IV access (median 1.00, IQR [1.00, 1.00]), disposition (median 1.00, IQR [1.00, 1.00]), team communication and dynamics (median 0.80, IQR [0.62, 1.00]).

Conclusions

The STAT taxonomy yielded 90.1% agreement and demonstrated excellent inter-rater reliability between reviewers in the in-situ simulation scenario. The STAT taxonomy may serve as a standardized evaluation tool of latent safety threats and adverse events in the trauma bay. Future work should focus on applying this tool to live trauma patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

A de-identified dataset associated with the paper is available upon reasonable request.

References

  1. Nolan B, Petrosoniak A, Hicks CM, Cripps MW, Dumas RP. Defining adverse events during trauma resuscitation: a modified RAND Delphi study. Trauma Surg Acute Care Open. 2021;6(1): e000805.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Nikouline A, Quirion A, Jung JJ, Nolan B. Errors in adult trauma resuscitation: a systematic review. Can J Emerg Med Care. 2021;23(4):537–46. https://doi.org/10.1007/s43678-021-00118-7

    Article  Google Scholar 

  3. Fitzgerald M, Gocentas R, Dziukas L, Cameron P, Mackenzie C, Farrow N. Using video audit to improve trauma resuscitation–time for a new approach. Can J Surg J Can De Chir. 2006;49(3):208–11.

    Google Scholar 

  4. Chang A, Schyve PM, Croteau RJ, O’Leary DS, Loeb JM. The JCAHO patient safety event taxonomy: a standardized terminology and classification schema for near misses and adverse events. Int J Qual Health C. 2005;17(2):95–105.

    Article  Google Scholar 

  5. Fan M, Petrosoniak A, Pinkney S, Hicks C, White K, Almeida APSS, et al. Study protocol for a framework analysis using video review to identify latent safety threats: trauma resuscitation using in situ simulation team training (TRUST). BMJ Open. 2016;6(11):e013683.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Petrosoniak A, Fan M, Hicks CM, White K, McGowan M, Campbell D, et al. Trauma Resuscitation Using in situ Simulation Team Training (TRUST) study: latent safety threat evaluation using framework analysis and video review. Bmj Qual Saf. 2021;30(9):739–46. https://doi.org/10.1136/bmjqs-2020-011363

  7. Dumas RP, Vella MA, Hatchimonji JS, Ma L, Maher Z, Holena DN. Trauma video review utilization: a survey of practice in the United States. Am J Surg. 2020;219:49–53.

    Article  CAS  PubMed  Google Scholar 

  8. Dumas RP, Vella MA, Chreiman KC, Smith BP, Subramanian M, Maher Z, et al. Team assessment and decision making is associated with outcomes: a trauma video review analysis. J Surg Res. 2020;246:544–9.

    Article  PubMed  Google Scholar 

  9. Jung JJ, Jüni P, Lebovic G, Grantcharov T. First-year analysis of the operating room black box study. Ann Surg. 2018;271(1):122–7. https://doi.org/10.1097/SLA.0000000000002863

    Article  Google Scholar 

  10. Nolan B, Hicks CM, Petrosoniak A, Jung J, Grantcharov T. Pushing boundaries of video review in trauma: using comprehensive data to improve the safety of trauma care. Trauma Surg Acute Care Open. 2020;5(1): e000510.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20(1):37–46.

    Article  Google Scholar 

  12. Gwet KL. Computing inter-rater reliability and its variance in the presence of high agreement. Br J Math Stat Psychol. 2008;61(1):29–48.

    Article  PubMed  Google Scholar 

  13. McHugh ML. Interrater reliability: the kappa statistic. Biochem Medica. 2012;22(3):276–82.

    Article  Google Scholar 

  14. Adams-McGavin RC, Jung JJ, van Dalen ASHM, Grantcharov TP, Schijven MP. System factors affecting patient safety in the OR: an analysis of safety threats and resiliency. Ann Surg. 2019;274(1):114–9. https://doi.org/10.1097/SLA.0000000000003616

    Article  Google Scholar 

  15. Quirion A, Nikouline A, Jung J, Nolan B. 2021 Contemporary uses of trauma video review: a scoping review. CJEM. 2021;23(6):787–96. https://doi.org/10.1007/s43678-021-00178-9

    Article  PubMed  Google Scholar 

  16. Gray A, Chartier LB, Pavenski K, McGowan M, Lebovic G, Petrosoniak A. 2020 The clock is ticking: using in situ simulation to improve time to blood administration for bleeding trauma patients. CJEM. 2021;23(1):54–62. https://doi.org/10.1007/s43678-020-00011-9

    Article  PubMed  Google Scholar 

  17. LaGrone LN, McIntyre L, Riggle A, Robinson BRH, Maier RV, Bulger E, et al. Changes in error patterns in unanticipated trauma deaths during 20 years: in pursuit of zero preventable deaths. J Trauma Acute Care. 2020;89(6):1046–53.

    Article  Google Scholar 

  18. Nagaraj MB, Lowe JE, Marinica AL, Morshedi BB, Isaacs SM, Miller BL, et al. Using Trauma Video Review to Assess EMS Handoff and Trauma Team Non-Technical Skills. Prehosp Emerg Care. 2021;22:1–8.

    Article  Google Scholar 

  19. Iedema R, Ball C, Daly B, Young J, Green T, Middleton PM, et al. Design and trial of a new ambulance-to-emergency department handover protocol: ‘IMIST-AMBO.’ Bmj Qual Saf. 2012;21(8):627.

    Article  PubMed  Google Scholar 

  20. Patterson MD, Geis GL, Falcone RA, LeMaster T, Wears RL. In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. Bmj Qual Saf. 2013;22(6):468.

    Article  PubMed  Google Scholar 

  21. Wheeler DS, Geis G, Mack EH, LeMaster T, Patterson MD. High-reliability emergency response teams in the hospital: improving quality and safety using in situ simulation training. Bmj Qual Saf. 2013;22(6):507.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Physician Services Incorporated and the St. Michael’s Hospital Association Alternate Funds Plan for their financial support for this study. We also thank Melissa McGowan and Richard Wu for their assistance in study coordination.

Funding

BN was supported by Physician Services Incorporated and the St. Michael’s Hospital Association Alternate Funds Plan. The funders did not have a role in study design, data analysis, interpretation of the results, writing the manuscript, or submitting the article for publication.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, St. Michael’s Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    Nemanja Baletic, Andrew Petrosoniak & Brodie Nolan

  2. Department of Surgery, Division of Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts General Hospital/Shriner’s Hospitals for Children-Boston, Boston, MA, USA

    Nemanja Baletic

  3. Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada

    Jamie Riggs, Andrew Petrosoniak & Brodie Nolan

  4. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada

    Gerald Lebovic, Andrew Petrosoniak & Brodie Nolan

  5. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Gerald Lebovic

  6. Department of Surgery, Division of Burn, Trauma, Acute and Critical Care Surgery, University of Texas Southwestern, UT Southwestern Medical Center, Dallas, TX, USA

    Ryan P. Dumas

Authors
  1. Nemanja Baletic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jamie Riggs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gerald Lebovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrew Petrosoniak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryan P. Dumas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Brodie Nolan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BN, NB, JR, GL, AP, and RD conceived and designed the study. BN obtained research ethics approval. NB, JR, and BN performed data collection. NB, BN and GL analyzed the data. BN and NB drafted the manuscript, and all authors contributed substantially to its revision. BN takes responsibility for the paper as a whole.

Corresponding author

Correspondence to Brodie Nolan.

Ethics declarations

Conflict of interest

There are no conflicts of interest to declare.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 245 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baletic, N., Riggs, J., Lebovic, G. et al. Introducing the Safety Threats and Adverse events in Trauma (STAT) taxonomy: standardized classification system for evaluating safety during trauma resuscitation. Eur J Trauma Emerg Surg 48, 4775–4781 (2022). https://doi.org/10.1007/s00068-022-02007-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-022-02007-9

Keywords

Search

Navigation