From the Division of Pediatric Critical Care Medicine, Department of Pediatrics.
Department of Neurosurgery, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health.
Pediatr Emerg Care. 2022 Jan 1;38(1):e337-e342. doi: 10.1097/PEC.0000000000002277.
Abusive head trauma (AHT) is a very common and serious form of physical abuse, and a major cause of mortality and morbidity for young children. Early Recognition and supportive care of children with AHT is a common challenge in community emergency department (CEDs). We hypothesized that standardized, in situ simulation can be used to measure and compare the quality of resuscitative measures provided to children with AHT in a diverse set of CEDs.
This prospective, simulation-based study measured teams' performance across CEDs. The primary outcome was overall adherence to AHT using a 15-item performance assessment checklist based on the number of tasks performed correctly on the checklist.
Fifty-three multiprofessional teams from 18 CEDs participated in the study. Of 270 participants, 20.7% were physicians, 65.2% registered nurses, and 14.1% were other providers. Out of all tasks, assessment of airway/breathing was the most successfully conducted task by 53/53 teams (100%). Although 43/53 teams (81%) verbalized the suspicion for AHT, only 21 (39.6%) of 53 teams used hyperosmolar agent, 4 (7.5%) of 53 teams applied cervical spine collar stabilization, and 6 (11.3%) of 53 teams raised the head of the bed. No significant difference in adherence to the checklist was found in the CEDs with an inpatient pediatric service or these with designated adult trauma centers compared with CEDs without. Community emergency departments closer to the main academic center outperformed CEDs these that are further away.
This study used in situ simulation to describe quality of resuscitative care provided to an infant presenting with AHT across a diverse set of CEDs, revealing variability in the initial recognition and stabilizing efforts and provided and targets for improvement. Future interventions focusing on reducing these gaps could improve the performance of CED providers and lead to improved patient outcomes.
虐待性头部外伤（AHT）是一种非常常见且严重的身体虐待形式，也是导致幼儿死亡率和发病率的主要原因。在社区急诊部（CED）中，早期识别和支持 AHT 患儿的治疗是一项常见挑战。我们假设，可以使用标准化的现场模拟来衡量和比较不同 CED 中 AHT 患儿复苏措施的质量。
这项前瞻性、基于模拟的研究测量了 CED 中各团队的表现。主要结果是根据清单上正确完成的任务数量，使用 15 项表现评估检查表来评估 AHT 的整体依从性。
来自 18 个 CED 的 53 个多专业团队参加了这项研究。在 270 名参与者中，20.7%是医生，65.2%是注册护士，14.1%是其他医护人员。在所有任务中，气道/呼吸评估是 53/53 个团队（100%）最成功完成的任务。尽管 43/53 个团队（81%）口头怀疑存在 AHT，但只有 21/53 个团队（39.6%）使用高渗剂，4/53 个团队（7.5%）应用颈椎固定圈稳定，6/53 个团队（11.3%）抬高床头。有住院儿科服务的 CED 或有指定成人创伤中心的 CED 与没有的 CED 相比，在遵守清单方面没有显著差异。离主要学术中心更近的社区急诊部的表现优于离得更远的社区急诊部。
本研究使用现场模拟描述了在不同的 CED 中为患有 AHT 的婴儿提供的复苏护理质量，揭示了在初步识别和稳定努力方面存在差异，并为改进提供了目标。未来专注于减少这些差距的干预措施可以提高 CED 提供者的表现，并改善患者的预后。
