Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Simulation-based training is associated with lower risk-adjusted mortality in ACS pediatric TQIP centers

Jensen, Aaron R. MD, MEd, MS; McLaughlin, Cory MD; Subacius, Haris MA; McAuliff, Katie PhD; Nathens, Avery B. MD, MPH, PhD; Wong, Carolyn PhD; Meeker, Daniella PhD; Burd, Randall S. MD, PhD; Ford, Henri R. MD, MHA; Upperman, Jeffrey S. MD

Journal of Trauma and Acute Care Surgery: October 2019 - Volume 87 - Issue 4 - p 841–848
doi: 10.1097/TA.0000000000002433

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 nonresponders (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 with centers not using simulation (odds ratio, 0.58; 95% confidence interval, 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.

CONCLUSION 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 Therapeutic/care management, Level III

From the Division of Pediatric Surgery (A.R.J.), UCSF Benioff Children's Hospital Oakland, Oakland; Department of Surgery (A.R.J.), University of California San Francisco School of Medicine, San Francisco; Division of Pediatric Surgery (C.M., J.S.U.), Children's Hospital Los Angeles; Department of Surgery (C.M., J.S.U.), Keck School of Medicine of the University of Southern California; Southern California Clinical and Translational Science Institute (SC-CTSI) (C.W., D.M.), Los Angeles, California; American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) (H.S., K.M., A.B.N.), Chicago, Illinois; Department of Surgery (A.B.N.), University of Toronto, Toronto, ON, Canada; Department of Pediatrics (C.W.), Children's Hospital Los Angeles, Department of Preventive Medicine (D.M.), Keck School of Medicine of the University of Southern California, Los Angeles, California; Division of Burn and Trauma Surgery (R.S.B.), Children's National Medical Center, Washington, District of Columbia; Miller School of Medicine (H.R.F.), University of Miami, Miami, Florida.

Submitted: April 4, 2019, Revised: May 24, 2019, Accepted: May 29, 2019, Published online: July 3, 2019.

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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Aaron R Jensen, MD, MEd, MS, UCSF, Pediatric General Surgery, Benioff Children's Hospital Oakland, 4th Floor, 744 52nd St, OPC 2, Oakland, CA; email:

Online date: July 8, 2019

© 2019 Lippincott Williams & Wilkins, Inc.