Effects of the application of a checklist during trauma resuscitations on ATLS adherence, team performance, and patient-related outcomes: a systematic review

Abstract

Purpose In this systematic literature review, the effects of the application of a checklist during in hospital resuscitation of trauma patients on adherence to the ATLS guidelines, trauma team performance, and patient-related outcomes were integrated. Methods A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Metaanalyses checklist. The search was performed in Pubmed, Embase, CINAHL, and Cochrane inception till January 2019. Randomized controlled-or controlled before-and-after study design were included. All other forms of observational study designs, reviews, case series or case reports, animal studies, and simulation studies were excluded. The Effective Public Health Practice Project Quality Assessment Tool was applied to assess the methodological quality of the included studies. Results Three of the 625 identified articles were included, which all used a before-and-after study design. Two studies showed that Advanced Trauma Life Support (ATLS)-related tasks are significantly more frequently performed when a checklist was applied during resuscitation. [14 of 30 tasks (p < 0.05), respectively, 18 of 19 tasks (p < 0.05)]. One study showed that time to task completion (− 9 s, 95% CI = − 13.8 to − 4.8 s) and workflow improved, which was analyzed as model fitness (0.90 vs 0.96; p < 0.001); conformance frequency (26.1% vs 77.6%; p < 0.001); and frequency of unique workflow traces (31.7% vs 19.1%; p = 0.005). One study showed that the incidence of pneumonia was higher in the group where a checklist was applied [adjusted odds ratio (aOR) 1.69, 95% Confidence Interval (CI 1.03-2.80)]. No difference was found for nine other assessed complications or missed injuries. Reduced mortality rates were found in the most severely injured patient group (Injury Severity score > 25, aOR 0.51, 95% CI 0.30-0.89). Conclusions The application of a checklist may improve ATLS adherence and workflow during trauma resuscitation. Current literature is insufficient to truly define the effect of the application of a checklist during trauma resuscitation on patientrelated outcomes, although one study showed promising results as an improved chance of survival for the most severely injured patients was found.

Structured approach with primary and secondary survey for major trauma care: an overview of reviews

“…One SR [ 28 ] including one study reported this outcome in the adult population. The incidence of one of the ten complications (pneumonia) was slightly higher after the introduction of the checklist (aOR 1.69, 95% CI 1.03–2.80).…”

“…One SR [ 28 ] including one study reported this outcome in 3422 adult trauma patients: incidence of missed injuries did not differ before and implementation of a checklist (aOR 0.62; 95% CI 0.19–2.03; p = 0.437).…”

“…One SR [ 28 ] including two studies reported this outcome without performing a meta-analysis. In one study in the paediatric setting, 14 of the 30 ATLS tasks were completed by doctors more often after checklist introduction (for all p ≤ 0.01).…”

“…Secondarily, the control group encompassed all non-routine WBCT-related protocols (both ATLS and strictly selective CT), as the definition of “conventional” varies among countries and even between institutions within the same region. Third, in the first comparison, one SR included both adult and children population reporting separate results according to a specific population [ 28 ], whereas in the second comparison the paediatric field was not assessed and we were aware that the management of injuries (including the use of imaging and different modalities) is not the same. Thus, these findings cannot be generalized to children.…”

Impact of a shared decision-making mHealth tool on caregivers’ team situational awareness, communication effectiveness, and performance during pediatric cardiopulmonary resuscitation: study protocol of a cluster randomized controlled trial

“…By contrast, p-OHCA accounts for a further 7037 children brought to United States PEDs each year [1]. Variable adherence to resuscitation algorithms is commonly observed and can hinder optimal trauma and CPR care, thus jeopardizing patient outcome and survival [60][61][62][63][64]. In addition to the technical skills of individual rescuers, shared mental non-technical skills at the team level such as SA, collective team interaction patterns, leadership, and dynamic decision-making affect adherence to algorithms and hence the outcome of resuscitation care [22,65].…”