Shock Trauma Anesthesiology Research, University of Maryland School of Medicine, Baltimore, MD.
Joint Trauma System, Defense Center of Excellence for Trauma, San Antonio, TX.
Surgery. 2019 Nov;166(5):835-843. doi: 10.1016/j.surg.2019.05.031. Epub 2019 Jul 25.
Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors.
In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts.
Resident trauma readiness index increased with training (P < .001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P < .05). Expert trauma readiness index was higher than residents (P < .004) and practicing surgeons (P < .001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index <0.60 or <6 decile in their cohort, predicts a surgeon will make a critical error.
Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention.
严重错误会增加术后发病率和死亡率。创伤准备指数用于评估 4 种创伤程序中的严重错误。与实践和专家外科医生基准相比，我们假设包括血管和非血管创伤手术程序的术前创伤准备指数可以识别出可能犯严重错误的住院医师。
在一项前瞻性研究中，经过培训的评估员使用标准化脚本评估了在未经保存的尸体上进行肱动脉、腋动脉和股动脉暴露以及近端控制和下肢筋膜切开术的表现。40 名住院医师在接受高级创伤暴露手术技能培训之前和之后立即接受评估，其中 38 名在 14 个月后再次接受评估。住院医师与 34 名在培训后 30 个月接受评估的执业外科医生以及 10 名专家进行比较。
住院医师的创伤准备指数随培训而增加（P <.001），14 个月后保持不变，且高于执业外科医生（P <.05），方差较低。专家的创伤准备指数高于住院医师（P <.004）和执业外科医生（P <.001）。住院医师在接受高级创伤暴露手术技能培训后立即和 14 个月后，创伤准备指数降低了严重错误。执业外科医生的严重错误和表现变异性高于住院医师或专家。专家的错误恢复能力比执业外科医生或住院医师高出 5 到 7 倍。在他们的队列中，创伤准备指数的受试者工作特征曲线下面积小于 0.60 或小于 6 个十分位数，预测外科医生会犯严重错误。
低创伤准备指数与所有外科医生队列中发生的严重错误有关，并且可以识别需要补救干预的外科医生。
