评估一级创伤中心的创伤团队表现：创伤团队沟通评估（TTCA-24）的验证
Evaluating trauma team performance in a Level I trauma center: Validation of the trauma team communication assessment (TTCA-24).
作者信息
DeMoor Stephanie, Abdel-Rehim Shady, Olmsted Richard, Myers John G, Parker-Raley Jessica
机构信息
From the Department of Surgery (S.DM., R.O.), Department of Surgery (S.A.R., J.G.M., J.P.R.), University of Texas Health Science Center San Antonio, San Antonio, Texas.
出版信息
J Trauma Acute Care Surg. 2017 Jul;83(1):159-164. doi: 10.1097/TA.0000000000001526.
BACKGROUND
Nontechnical skills (NTS), such as team communication, are well-recognized determinants of trauma team performance and good patient care. Measuring these competencies during trauma resuscitations is essential, yet few valid and reliable tools are available. We aimed to demonstrate that the Trauma Team Communication Assessment (TTCA-24) is a valid and reliable instrument that measures communication effectiveness during activations.
METHODS
Two tools with adequate psychometric strength (Trauma Nontechnical Skills Scale [T-NOTECHS], Team Emergency Assessment Measure [TEAM]) were identified during a systematic review of medical literature and compared with TTCA-24. Three coders used each tool to evaluate 35 stable and 35 unstable patient activations (defined according to Advanced Trauma Life Support criteria). Interrater reliability was calculated between coders using the intraclass correlation coefficient. Spearman rank correlation coefficient was used to establish concurrent validity between TTCA-24 and the other two validated tools.
RESULTS
Coders achieved an intraclass correlation coefficient of 0.87 for stable patient activations and 0.78 for unstable activations scoring excellent on the interrater agreement guidelines. The median score for each assessment showed good team communication for all 70 videos (TEAM, 39.8 of 54; T-NOTECHS, 17.4 of 25; and TTCA-24, 87.4 of 96). A significant correlation between TTTC-24 and T-NOTECHS was revealed (p = 0.029), but no significant correlation between TTCA-24 and TEAM (p = 0.77). Team communication was rated slightly better across all assessments for stable versus unstable patient activations, but not statistically significant.
CONCLUSION
TTCA-24 correlated with T-NOTECHS, an instrument measuring nontechnical skills for trauma teams, but not TEAM, a tool that assesses communication in generic emergency settings. TTCA-24 is a reliable and valid assessment that can be a useful adjunct when evaluating interpersonal and team communication during trauma activations.
LEVEL OF EVIDENCE
Diagnostic tests or criteria, level II.
背景
非技术技能（NTS），如团队沟通，是创伤团队表现和良好患者护理的公认决定因素。在创伤复苏过程中衡量这些能力至关重要，但可用的有效且可靠的工具很少。我们旨在证明创伤团队沟通评估（TTCA - 24）是一种有效且可靠的工具，可用于衡量启动过程中的沟通效果。
方法
在对医学文献的系统评价中确定了两种具有足够心理测量强度的工具（创伤非技术技能量表 [T - NOTECHS]、团队紧急评估量表 [TEAM]），并与TTCA - 24进行比较。三名编码员使用每种工具评估35例稳定和35例不稳定患者启动情况（根据高级创伤生命支持标准定义）。使用组内相关系数计算编码员之间的评分者间信度。使用Spearman等级相关系数建立TTCA - 24与其他两种经过验证的工具之间的同时效度。
结果
对于稳定患者启动情况，编码员的组内相关系数为0.87，对于不稳定启动情况为0.78，在评分者间一致性指南上得分优秀。每次评估的中位数得分显示所有70个视频的团队沟通良好（TEAM，54分中的39.8分；T - NOTECHS，25分中的17.4分；TTCA - 24，96分中的87.4分）。TTTC - 24与T - NOTECHS之间存在显著相关性（p = 0.029），但TTCA - 24与TEAM之间无显著相关性（p = 0.77）。在所有评估中，稳定患者启动情况的团队沟通评分略高于不稳定患者启动情况，但无统计学意义。
结论
TTCA - 24与T - NOTECHS相关，T - NOTECHS是一种衡量创伤团队非技术技能的工具，但与TEAM不相关，TEAM是一种评估一般紧急情况下沟通的工具。TTCA - 24是一种可靠且有效的评估工具，在评估创伤启动过程中的人际和团队沟通时可作为有用的辅助工具。
证据水平
诊断试验或标准，二级。
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