Evaluación de la actuación de los pediatras de atención primaria en un escenario simulado de trauma pediátrico

Resumo

Introduction: Training by means of advanced simulation can improve the paediatrician�s abilities in the management of paediatric trauma patients, as well as decreasing errors and increasing patient safety. The initial management is an essential factor in the outcome of an injured child. Material and methods: A trauma patient scenario was included in a national simulation training program. The performances of 156 paediatric primary care providers, divided into 39 teams, who participated in the courses carried out from May 2008 until February 2010 were retrospectively analysed. The evaluation of the scenario was based both on the primary survey suggested by the Working Group on Trauma of the SECIP, and in the 8 main targets of a simulation evaluation tool from the Cincinnati Children�s Hospital trauma care program. Results: A pulse oximeter was placed, the intravenous/intraosseous access was indicated, the blood pressure was checked, and the oxygen was applied In 100% ofthe scenarios. An intravenous ?uid bolus was indicated in 87% of the scenarios. The Glasgow scale was performed in 5.1%, and the appropriate warming measures in 25.6%. The bilateral cervical immobilisation was incorrect in 35% of the scenarios (89.7%). The primary survey (ABCDE) was checked correctly in only one scenario. With a top score of 16, based on Cincinnati Hospital, the teams mean score was 5.3 ±1.8. Conclusions: Primary care paediatricians have problems applying the primary ABCDE trauma care sequence and the cervical spine precautions in a trauma simulation scenario. Educational programs for paediatricians must improve the practical check points of the initial approach to trauma management.