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Simulation-Based Training is Associated with Lower Risk-Adjusted Mortality in ACS Pediatric TQIP Centers

Jensen, Aaron R. MD, MEd, MS1; McLaughlin, Cory MD2; Subacius, Haris MA4; McAuliff, Katie PhD4; Nathens, Avery B. MD, MPH, PhD4,5; Wong, Carolyn PhD3,6; Meeker, Daniella PhD3,7; Burd, Randall S. MD, PhD8; Ford, Henri R. MD, MHA9; Upperman, Jeffrey S. MD2

Journal of Trauma and Acute Care Surgery: July 3, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/TA.0000000000002433
AAST 2018 Poster: PDF Only

Background Although use of simulation-based team training for pediatric trauma resuscitation has increased, its impact on patient outcomes has not yet been shown. The purpose of this study was to determine the association between simulation use and patient outcomes.

Methods Trauma centers that participate in the American College of Surgeons (ACS) Pediatric Trauma Quality Improvement Program (TQIP) were surveyed to determine frequency of simulation use in 2014 and 2015. Center-specific clinical data for 2016 and 2017 were abstracted from the ACS TQIP registry (n=57,916 patients) and linked to survey responses. Center-specific risk-adjusted mortality was estimated using multivariable hierarchical logistic regression and compared across four levels of simulation-based training use: no training, low-volume training, high-volume training, and survey non-responders (unknown training use).

Results Survey response rate was 75% (94/125 centers) with 78% of the responding centers (73/94) reporting simulation use. The average risk-adjusted odds of mortality was lower in centers with a high volume of training compared to centers not using simulation (OR 0.58, 95% CI 0.37-0.92). The times required for resuscitation processes, evaluations, and critical procedures (endotracheal intubation, head computed tomography, craniotomy, and surgery for hemorrhage control) were not different between centers based on levels of simulation use.

Conclusions Risk-adjusted mortality is lower in TQIP-Pediatric centers using simulation-based training, but this improvement in mortality may not be mediated by a reduction in time to critical procedures. Further investigation into alternative mediators of improved mortality associated with simulation use is warranted, including assessment of resuscitation quality, improved communication, enhanced teamwork skills, and decreased errors.

Level of Evidence Level III therapeutic / care management

1Division of Pediatric Surgery, UCSF Benioff Children’s Hospital Oakland, Oakland, CA, and Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA

2Division of Pediatric Surgery, Children’s Hospital Los Angeles and Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA

3Southern California Clinical and Translational Science Institute (SC-CTSI), Los Angeles, CA

4American College of Surgeons Trauma Quality Improvement Program (ACS TQIP), Chicago, IL

5Department of Surgery, University of Toronto, Toronto, ON, Canada

6Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA

7Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA

8Division of Burn and Trauma Surgery, Children’s National Medical Center, Washington, DC

9Miller School of Medicine, University of Miami, Miami, FL

This work was presented as a poster at the 77th Annual Meeting of the American Association for the Surgery of Trauma, San Diego, CA, September 26, 2018.

None of the authors have any conflicts of interest to disclose. This work is not under consideration for publication in any other journal.

Children’s Hospital Los Angeles Institutional Review Board Exemption # CHLA-16-00341

This work was supported by grant #KFVS6290 from the National Institute for Child Health and Development (NICHD) and grant #KL2TR001854 from the National Center for Advancing Translational Science (NCATS) of the U.S. National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

© 2019 Lippincott Williams & Wilkins, Inc.