Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Lahey Hospital and Medical Center, Beth Israel Lahey, Burlington, MA. Electronic address: https://twitter.com/abbieEnaus.
Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Surgery, Yale New Haven Hospital, New Haven, CT.
J Surg Res. 2024 Jun;298:355-363. doi: 10.1016/j.jss.2024.03.038. Epub 2024 Apr 24.
Over 90% of pediatric trauma deaths occur in low- and middle-income countries (LMICs), yet pediatric trauma-focused training remains unstandardized and inaccessible, especially in LMICs. In Brazil, where trauma is the leading cause of death for children over age 1, we piloted the first global adaptation of the Trauma Resuscitation in Kids (TRIK) course and assessed its feasibility.
A 2-day simulation-based global TRIK course was hosted in Belo Horizonte in October 2022, led by one Brazilian and four Canadian instructors. The enrollment fee was $200 USD, and course registration sold out in 4 d. We administered a knowledge test before and after the course and a postcourse self-evaluation. We recorded each simulation to assess participants' performance, reflected in a team performance score. Groups received numerical scores for these three areas, which were equally weighted to calculate a final performance score. The scores given by the two evaluators were then averaged. As groups performed the specific simulations in varying orders, the simulations were grouped into four time blocks for analysis of performance over time. Statistical analysis utilized a combination of descriptive analysis, Wilcoxon signed-rank tests, Kruskal-Wallis tests, and Wilcoxon rank-sum tests.
Twenty-one surgeons (19 pediatric, one trauma, one general) representing four of five regions in Brazil consented to study participation. Women comprised 76% (16/21) of participants. Overall, participants scored higher on the knowledge assessment after the course (68% versus 76%; z = 3.046, P < 0.001). Participants reported improved knowledge for all tested components of trauma management (P < 0.001). The average simulation performance score increased from 66% on day 1% to 73% on day 2, although this increase was not statistically significant. All participants reported they were more confident managing pediatric trauma after the course and would recommend the course to others.
Completion of global TRIK improved surgeons' confidence, knowledge, and clinical decision-making skills in managing pediatric trauma, suggesting a standardized course may improve pediatric trauma care and outcomes in LMICs. We plan to more closely address cost, language, and resource barriers to implementing protocolized trauma training in LMICs with the aim to improve patient outcomes and equity in trauma care globally.
超过 90%的儿科创伤死亡发生在低收入和中等收入国家（LMICs），但儿科创伤重点培训仍然没有标准化，也无法普及，尤其是在 LMICs。在巴西，创伤是 1 岁以上儿童死亡的主要原因，我们试点了全球首个创伤复苏在儿童（TRIK）课程的适应性版本，并评估了其可行性。
2022 年 10 月，在贝洛奥里藏特举办了为期两天的基于模拟的全球 TRIK 课程，由一名巴西人和四名加拿大教员领导。注册费为 200 美元，课程注册在 4 天内售罄。我们在课程前后进行了知识测试，并进行了课后自我评估。我们记录了每个模拟，以评估参与者的表现，反映在团队表现分数中。小组在这三个领域的得分相同，加权计算最终表现得分。两名评估员的得分平均。由于小组以不同的顺序进行特定的模拟，因此将模拟分为四个时间块进行随时间的表现分析。统计分析结合了描述性分析、Wilcoxon 符号秩检验、Kruskal-Wallis 检验和 Wilcoxon 秩和检验。
21 名外科医生（19 名儿科，1 名创伤，1 名普通外科）代表巴西五个地区中的四个地区同意参与研究。女性占参与者的 76%（16/21）。总体而言，参与者在课后的知识评估中得分更高（68%对 76%；z=3.046，P<0.001）。参与者报告说，他们对所有测试的创伤管理组成部分的知识都有所提高（P<0.001）。模拟表现评分从第一天的 66%平均提高到第二天的 73%，尽管这一提高并不显著。所有参与者都表示，他们在课程后更有信心管理儿科创伤，并将推荐该课程给其他人。
完成全球 TRIK 课程提高了外科医生在管理儿科创伤方面的信心、知识和临床决策技能，表明标准化课程可能会改善 LMICs 中的儿科创伤护理和结果。我们计划更密切地解决成本、语言和资源障碍，以在 LMICs 中实施协议化创伤培训，旨在改善全球范围内的患者结局和创伤护理公平性。
