A priority driven ABC approach to the emergency management of high energy pelvic trauma improves decision making in simulated patient scenarios.

Authors
Daurka, Jasvinder S. ; Rankin, Iain ; Jaggard, M.K.J. ; Lewis, Angus

Introduction An ABC priority driven approach to the management of high energy pelvic injuries has been developed and applied as a teaching tool. A prospective study assessed whether trainees taught this ABC aide memoire gave better priority driven care in simulated patient scenarios. They were compared directly to colleagues undergoing the same pelvic training but without reference to the ABC concept. Methods Orthopaedic trainees were formally assessed by viva scenario upon their pelvic trauma management 6 weeks after a pelvic trauma teaching event. Trainees all received standard pelvic trauma teaching but were randomised into two groups. One group alone had an introduction to the ABC algorithm. Inclusion criteria were trainees belonging to the same deanery teaching group with similar levels of training and experience in pelvic trauma. Those completing a pelvic trauma post or teaching in pelvic trauma were excluded. Results There were 20 trainees included and three scenarios giving 60 scores. The mean year of training or the number of pelvic trauma cases experienced did not differ significantly between the groups ( p = 0.426 and p = 0.347). The ABC teaching concept yielded significant improvements in several aspects: coagulopathy assessment and management ( p = <0.001); urological injury ( p = 0.047), appropriate prioritisation ( p = 0.006) and bowel injury/open fracture assessment ( p = 0.007). A poorer response was seen in CT assessment ( p = 0.004). Discussion and conclusion The ABC priority driven approach to pelvic trauma management provides structure when decision making. This method improves clinician's recall, prioritisation and potentially clinical outcomes. ABSTRACT FROM AUTHOR

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The data generated was both non-parametric and parametric with a mixture of categorised and continuous scoring. Groups were compared directly using chi squared test for non-parametric data and Students t-test for parametric data. Data analyzed with SPSS

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Comparative study

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Pelvic criteria

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Trainees all received standard pelvic trauma teaching but were randomised into two groups. One group alone had an introduction to the ABC algorithm.

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performed on the results of a formative of trauma and orthopaedic trainees 6 weeks after a pelvic trauma management teaching event. Fifteen candidates were removed from the study due to not meeting the inclusion criteria. Nine candidates were randomised to the ‘control’ group and 11 candidates randomised to the ‘ABC’ teaching group.

SLR Criteria
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A prospective study assessed whether trainees taught this ABC aide memoire gave better priority driven care in simulated patient scenarios.

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Testing after 6 weeks of delivering the teaching is a short time period, the effect was significant. Our hope would be to demonstrate more long-term recall and change in clinical practice

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Using an initialled ABC acronym as a teaching method improves both clinician’s recall and prioritisation when discussing pelvic trauma in examination scenarios.

SLR Criteria
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Orthopaedic trainees were formally assessed by viva upon their pelvic trauma management 6 weeks after a pelvic trauma teaching event