Chang Todd P, Santillanes Genevieve, Claudius Ilene, Pham Phung K, Koved James, Cheyne John, Gausche-Hill Marianne, Kaji Amy H, Srinivasan Saranya, Donofrio J Joelle, Bir Cynthia
1Division of Emergency Medicine and Transport,Children's Hospital Los Angeles;Keck School of Medicine,University of Southern California,Los Angeles,CaliforniaUSA.
2Department of Emergency Medicine,Los Angeles County + University of Southern California Hospital;Keck School of Medicine,University of Southern California,Los Angeles,CaliforniaUSA.
Prehosp Disaster Med. 2017 Aug;32(4):451-456. doi: 10.1017/S1049023X17006343. Epub 2017 Mar 27.
Introduction A simple, portable capillary refill time (CRT) simulator is not commercially available. This device would be useful in mass-casualty simulations with multiple volunteers or mannequins depicting a variety of clinical findings and CRTs. The objective of this study was to develop and evaluate a prototype CRT simulator in a disaster simulation context.
A CRT prototype simulator was developed by embedding a pressure-sensitive piezo crystal, and a single red light-emitting diode (LED) light was embedded, within a flesh-toned resin. The LED light was programmed to turn white proportionate to the pressure applied, and gradually to return to red on release. The time to color return was adjustable with an external dial. The prototype was tested for feasibility among two cohorts: emergency medicine physicians in a tabletop exercise and second year medical students within an actual disaster triage drill. The realism of the simulator was compared to video-based CRT, and participants used a Visual Analog Scale (VAS) ranging from "completely artificial" to "as if on a real patient." The VAS evaluated both the visual realism and the functional (eg, tactile) realism. Accuracy of CRT was evaluated only by the physician cohort. Data were analyzed using parametric and non-parametric statistics, and mean Cohen's Kappas were used to describe inter-rater reliability.
The CRT simulator was generally well received by the participants. The simulator was perceived to have slightly higher functional realism (P=.06, P=.01) but lower visual realism (P=.002, P=.11) than the video-based CRT. Emergency medicine physicians had higher accuracy on portrayed CRT on the simulator than the videos (92.6% versus 71.1%; P<.001). Inter-rater reliability was higher for the simulator (0.78 versus 0.27; P<.001).
A simple, LED-based CRT simulator was well received in both settings. Prior to widespread use for disaster triage training, validation on participants' ability to accurately triage disaster victims using CRT simulators and video-based CRT simulations should be performed. Chang TP , Santillanes G , Claudius I , Pham PK , Koved J , Cheyne J , Gausche-Hill M , Kaji AH , Srinivasan S , Donofrio JJ , Bir C . Use of a novel, portable, LED-based capillary refill time simulator within a disaster triage context. Prehosp Disaster Med. 2017;32(4):451-456.
引言 一种简单、便携的毛细血管再充盈时间（CRT）模拟器尚无商业产品。该设备在涉及多名志愿者或模拟多种临床症状及CRT的人体模型的大规模伤亡模拟中会很有用。本研究的目的是在灾难模拟环境中开发并评估一种CRT模拟器原型。
通过将一个压敏压电晶体嵌入肉色树脂中，并嵌入一个红色发光二极管（LED）来开发CRT模拟器原型。LED被编程为根据施加的压力变为白色，并在压力释放时逐渐变回红色。颜色恢复时间可通过外部刻度盘调节。该原型在两个队列中进行了可行性测试：在桌面演练中的急诊医学医生和在实际灾难分诊演练中的二年级医学生。将模拟器的逼真度与基于视频的CRT进行比较，参与者使用从“完全不真实”到“如同在真实患者身上”的视觉模拟量表（VAS）。VAS评估视觉逼真度和功能（如触觉）逼真度。仅由医生队列评估CRT的准确性。使用参数和非参数统计分析数据，并使用平均科恩卡帕系数来描述评分者间的可靠性。
参与者对CRT模拟器总体评价良好。与基于视频的CRT相比，模拟器被认为具有略高的功能逼真度（P = 0.06，P = 0.01）但较低的视觉逼真度（P = 0.002，P = 0.11）。急诊医学医生在模拟器上对描绘的CRT的准确性高于视频（92.6%对71.1%；P < 0.001）。模拟器的评分者间可靠性更高（0.78对0.27；P < 0.001）。
一种简单的基于LED的CRT模拟器在两种环境中都受到好评。在将其广泛用于灾难分诊培训之前，应就参与者使用CRT模拟器和基于视频的CRT模拟准确分诊灾难受害者的能力进行验证。张TP，桑蒂拉内斯G，克劳迪乌斯I，范PK，科维德J，切恩J，高斯 - 希尔M，卡吉AH，斯里尼瓦桑S，多诺弗里奥JJ，比尔C。在灾难分诊环境中使用新型便携式基于LED的毛细血管再充盈时间模拟器。院前灾难医学。[2017年；32(4):451 - 456]
