Flood Shannon, Alletag Michelle, D'Amico Beth, Halstead Sarah, Mahar Patrick, Rochford Laura, Markowitz Geoffrey, Leonard Jan, Ambroggio Lilliam, Neubrand Tara
University of Colorado, Children's Hospital Colorado, 13123 E. 16 Ave, Aurora, CO, 80045, USA.
University of Colorado, Children's Hospital Colorado, Aurora, CO, USA.
Resusc Plus. 2024 Dec 12;21:100844. doi: 10.1016/j.resplu.2024.100844. eCollection 2025 Jan.
Resuscitation of paediatric cardiac and respiratory arrest is a high-stakes and low frequency event in the paediatric emergency department. Resuscitation team performance assessment tools have been developed and validated for use in the simulation environment, but no tool currently exists to evaluate clinical performance in non-simulated, live paediatric resuscitations.
This is a validation study assessing inter-rater reliability of a novel assessment tool of clinical performance of non-simulated resuscitations, the Team Resuscitation for Paediatrics tool. Videos of medical resuscitations at a tertiary care paediatric emergency department were collected and analysed over a 6-month period. Four paediatric emergency medicine attending physicians reviewed the videos and scored team performance based on the tool. Percent agreement and Fleiss' Kappa were calculated in 3 subcategories: team communication, cardiac arrest and respiratory arrest. Percent agreement ranges were established a priori as > 80 % considered good and < 60 % poor.
Of 51 resuscitations occurring during the study period, 24 met inclusion criteria. All subcategories demonstrated overall moderate agreement however individual items showed a wide range of agreement. Kappa scores were low on both individual items and overall. Three of four items on the team communication tool met criteria for good agreement, 12/34 items on the cardiac arrest tool met good agreement and 9/27 items on the respiratory arrest tool met good agreement.
This study demonstrated that development, application and testing of clinical tools to assess resuscitation team performance of non-simulated, video-recorded resuscitations is feasible, however, the Team Resuscitation for Paediatrics tool did not demonstrate adequate inter-rater reliability suggesting that further tool development may be necessary to better evaluate clinical resuscitation performance.
小儿心脏骤停和呼吸骤停的复苏是儿科急诊科中高风险且低发生率的事件。复苏团队绩效评估工具已在模拟环境中开发并验证，但目前尚无工具可用于评估非模拟的现场小儿复苏中的临床表现。
这是一项验证性研究，评估一种用于评估非模拟复苏临床表现的新型评估工具——儿科团队复苏工具的评分者间信度。在6个月的时间里收集并分析了一家三级护理儿科急诊科的医疗复苏视频。四名儿科急诊医学主治医师观看了视频，并根据该工具对团队表现进行评分。在团队沟通、心脏骤停和呼吸骤停3个子类别中计算一致性百分比和Fleiss' Kappa系数。预先设定一致性百分比范围，>80%为良好，<60%为较差。
在研究期间发生的51次复苏中，24次符合纳入标准。所有子类别总体上显示出中等程度的一致性，但各个项目的一致性范围较宽。单个项目和总体的Kappa系数都很低。团队沟通工具中的4个项目中有3个符合良好一致性标准，心脏骤停工具中的34个项目中有12个符合良好一致性标准，呼吸骤停工具中的27个项目中有9个符合良好一致性标准。
本研究表明，开发、应用和测试用于评估非模拟、视频记录的复苏中复苏团队表现的临床工具是可行的，然而，儿科团队复苏工具并未显示出足够的评分者间信度，这表明可能需要进一步开发工具以更好地评估临床复苏表现。
