Pediatric trauma primary survey performance among surgical and non-surgical pediatric providers in a Brazilian trauma center

Abstract

IntroductionTrauma is the leading cause of death and disability among Brazilian children and adolescents. Trauma protocols such as those developed by the Advanced Trauma Life Support course are widely taught, but few studies have assessed the degree to which the use of protocolized trauma assessment improves outcomes. This study aims to quantify the adherence of trauma assessment protocols among different types of frontline trauma providers.MethodsA prospective observational study of pediatric trauma care in one of the busiest Latin American trauma centers was conducted during 6 months. Trauma primary survey assessments were observed and adherence to each step of a standardized primary assessment protocol was recorded. Adherence to the assessment protocol was compared among different types of providers, the time of presentation and severity of injury. The relationship between protocol adherence and clinical outcomes including mortality, length of hospital stay, admission to pediatric intensive care unit, use of blood components, mechanical ventilation and number of imaging exams performed in the first 24 hours were also assessed.ResultsEmergency department evaluations of 64 patients out of 274 pediatric admissions were observed over a period of 6 months. 50% of the primary assessments were performed by general surgeons, 34.4% by residents in general surgery and 15.6% by pediatricians. There was an average adherence rate of 34.1% to the trauma protocol. Adherence among each specific step included airway: 17.2%; breathing: 59.4%; circulation: 95.3%; disability: 28.8%; exposure: 18.8%. No differences between specialties were observed. Patients with a more thorough primary assessment underwent fewer CT scans (receiver operating characteristic curve area: 0.661; p=0.027).ConclusionsOur study demonstrates that trauma assessment protocol adherence among trauma providers is low. Thorough initial assessment reduced the use of CT scans suggesting that standardized pediatric trauma assessments may be a way to reduce unnecessary radiological imaging among children.Level of evidenceIV.Study typePediatric and global trauma.

Global Research Trends in Pediatric Trauma From 1968 to 2021: A Bibliometric Analysis

“…It is also used to improve trauma outcomes. Despite widespread ATLS training, pediatric trauma centers often fail to follow the ATLS protocol (4).…”

Teaching Trauma in Resource‐Limited Settings: A Scoping Review of Pediatric Trauma Courses

“…Although ATLS training is a foundational trauma education course widely available globally, its impact on reducing the burden of childhood injury deaths in LMICs has not been established. In addition, more than 80% of ATLS‐trained healthcare providers in a Brazilian trauma center requested further targeted education in pediatric trauma [4, 26]. Our research group has also demonstrated poor adherence to ATLS protocols among trauma surgeons when assessing pediatric cases in the setting of an LMIC [4, 26].…”

“…In addition, more than 80% of ATLS‐trained healthcare providers in a Brazilian trauma center requested further targeted education in pediatric trauma [4, 26]. Our research group has also demonstrated poor adherence to ATLS protocols among trauma surgeons when assessing pediatric cases in the setting of an LMIC [4, 26]. Simple clinical interventions such as a checklist were unfortunately shown to be ineffective in the absence of meaningful change in the institutional education program [2, 4, 26].…”

“…The magnitude of childhood injury deaths in LMICs is multifactorial. Suggested causes include the impact of prehospital systems, emergency department management, low adherence to care protocols, lack of confidence among healthcare professionals, and limited pediatric trauma education [2][3][4][5]. Examples of initiatives aimed at improving pre-hospital systems and emergency management in LMICs include the training of laypersons in the stabilization and transport of trauma patients and the elaboration of the emergency triage assessment and treatment (ETAT) course by the WHO [6][7][8].…”

“…Such courses have been adapted to resource-limited settings [2,13], and are well-identified in the literature [9]. However, the impact of general trauma training courses on pediatric trauma outcomes is complicated by the particularities of children's anatomy and physiology, as well as the decreased confidence of healthcare providers in assessing and managing pediatric trauma cases [3][4][5]. In many LMICs, healthcare workers responsible for the management and treatment of pediatric trauma have not received appropriate training to do so [2].…”