Geis Gary L, Wheeler Derek S, Bunger Amy, Militello Laura G, Taylor Regina G, Bauer Jerome P, Byczkowski Terri L, Kerrey Benjamin T, Patterson Mary D
From the Cincinnati Children's Hospital Medical Center (G.L.G., D.S.W., R.G.T., J.B., T.B., B.T.K.); University of Cincinnati Medical Center (A.B.); Applied Decision Science (L.G.M.), LLC; and Children's National Medical Center (M.D.P.), Cincinnati, OH.
Simul Healthc. 2018 Feb;13(1):16-26. doi: 10.1097/SIH.0000000000000271.
Early recognition of sepsis remains one of the greatest challenges in medicine. Novice clinicians are often responsible for the recognition of sepsis and the initiation of urgent management. The aim of this study was to create a validity argument for the use of a simulation-based training course centered on assessment, recognition, and early management of sepsis in a laboratory-based setting.
Five unique simulation scenarios were developed integrating critical sepsis cues identified through qualitative interviewing. Scenarios were piloted with groups of novice, intermediate, and expert pediatric physicians. The primary outcome was physician recognition of sepsis, measured with an adapted situation awareness global assessment tool. Secondary outcomes were physician compliance with pediatric advanced life support (PALS) guidelines and early sepsis management (ESM) recommendations, measured by two internally derived tools. Analysis compared recognition of sepsis by levels of expertise and measured association of sepsis recognition with the secondary outcomes.
Eighteen physicians were recruited, six per study group. Each physician completed three sepsis simulations. Sepsis was recognized in 19 (35%) of 54 simulations. The odds that experts recognized sepsis was 2.6 [95% confidence interval (CI) = 0.5-13.8] times greater than novices. Adjusted for severity, for every point increase in the PALS global performance score, the odds that sepsis was recognized increased by 11.3 (95% CI = 3.1-41.4). Similarly, the odds ratio for the PALS checklist score was 1.5 (95% CI = 0.8-2.6). Adjusted for severity and level of expertise, the odds of recognizing sepsis was associated with an increase in the ESM checklist score of 1.8 (95% CI = 0.9-3.6) and an increase in ESM global performance score of 4.1 (95% CI = 1.7-10.0).
Although incomplete, evidence from initial testing suggests that the simulations of pediatric sepsis were sufficiently valid to justify their use in training novice pediatric physicians in the assessment, recognition, and management of pediatric sepsis.
脓毒症的早期识别仍然是医学领域面临的最大挑战之一。新手临床医生通常负责脓毒症的识别及启动紧急治疗。本研究的目的是为在实验室环境中开展的以脓毒症评估、识别和早期治疗为核心的模拟培训课程构建一个效度论证。
通过定性访谈确定关键脓毒症线索，据此设计了五个独特的模拟场景。这些场景在新手、中级和专家级儿科医生群体中进行了预试验。主要结局是使用经过改编的态势感知全局评估工具来衡量医生对脓毒症的识别情况。次要结局是通过两个内部衍生工具来衡量医生对儿科高级生命支持（PALS）指南和早期脓毒症管理（ESM）建议的依从性。分析比较了不同专业水平医生对脓毒症的识别情况，并衡量了脓毒症识别与次要结局之间的关联。
共招募了18名医生，每个研究组6名。每位医生完成了三次脓毒症模拟。在54次模拟中有19次（35%）识别出脓毒症。专家识别出脓毒症的几率比新手高2.6倍[95%置信区间（CI）=0.5 - 13.8]。校正严重程度后，PALS全局绩效评分每增加1分，识别出脓毒症的几率增加11.3（95%CI = 3.1 - 41.4）。同样，PALS检查表评分的优势比为1.5（95%CI = 0.8 - 2.6）。校正严重程度和专业水平后，识别出脓毒症的几率与ESM检查表评分增加1.8（95%CI = 0.9 - 3.6）以及ESM全局绩效评分增加4.1（95%CI = 1.7 - 10.0）相关。
尽管尚不完整，但初步测试的证据表明，儿科脓毒症模拟具有足够的效度，足以证明其可用于培训新手儿科医生进行儿科脓毒症的评估、识别和治疗。
