common error, while delaying the test when ordered was also significant. Future training in pediatric ... VALIDItY OF tHE cANADIAN trIAGE AND AcuItY scALE.
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Conclusions: The scoring instrument was able to demonstrate significant improvements in scores following a PALS course for PGY1 and PGY3 pediatric residents for the pulseless non-shockable arrest, pulseless shockable and respiratory arrest scenarios only. However, it was unable to discriminate between PGY1’s and PGY3’s both before and after the PALS course for any scenarios. The scoring instrument showed excellent interreliability for all scenarios.
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DELAYS AND ERRORS AMONG PEDIATRIC RESIDENTS DURING SIMULATED RESUSCITATION SCENARIOS USING PALS ALGORITHMS *A Levy, M Labrosse, A Donoghue, J Gravel Division of Emergency Medicine, Department of Pediatrics, Centre hospitalier Sainte-Justine, Montreal, Quebec Background: Recent data suggest alarming delays and deviations in major components of pediatric resuscitation during simulated scenarios by pediatric housestaff. Objectives: To identify the most common errors of pediatric residents during multiple simulated pediatric resuscitation scenarios. Design/Methods: A retrospective observational study was conducted in an academic tertiary care hospital. Participants were all pediatric residents (PGY1 and PGY3) from the same center. They were videotaped performing a series of five pediatric resuscitation scenarios using a highfidelity simulator (Simbaby, Laerdal): pulseless non-shockable arrest, pulseless shockable arrest, dysrhythmia, respiratory arrest and shock. The primary outcome was the presence of significant errors prospectively defined using a validated scoring instrument designed to assess sequence, timing and quality of specific actions during resuscitations based on the 2005 AHA PALS guidelines. Residents’ clinical performances were measured by a single video reviewer. The primary analysis was the proportion of errors for each critical task for each scenario. It was estimated that the evaluation of each resident would provide a confidence interval smaller than 0.20 for the proportion of errors. Results: Twenty-four of 25 residents completed the study. Across all scenarios, pulse check was delayed by more than 30 seconds in 56% (95% CI: 46-66%). For non-shockable arrest, CPR was started more than 30 seconds after recognizing arrest in 21% (95% CI 7-42%) and inappropriate defibrillation was performed in 29% (95% CI: 13-51%). For shockable arrest, participants failed to identify the rhythm in 58% (95% CI 37-78%), CPR was not performed in 25% (95% CI: 10-47%) while defibrillation was delayed by more than 90 seconds in 33% (95% CI 16-51%) and not performed in one case. For shock, participants never asked for a rapid dextrose check in 71% (95% CI 51-86%), and it was delayed by more than 60 seconds for all others. Conclusions: The most common error across all scenarios was a delay in pulse check. Delays in starting CPR and inappropriate defibrillation were common errors in non-shockable arrests, while failure to identify rhythm, CPR omission and delaying defibrillation were noted for shockable arrests. For shock, omission of rapid dextrose check was the most common error, while delaying the test when ordered was also significant. Future training in pediatric resuscitation should target these errors.
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VALIDITY OF THE CANADIAN TRIAGE AND ACUITY SCALE FOR CHILDREN: A MULTI-CENTRE, DATABASE STUDY *J Gravel, E Fitzpatrick, K Millar, S Curtis, G Joubert, K Boutis, C Guimont, RD Goldman, S Dubrovsky, R Porter, D Beer, MH Osmond Centre hospitalier Sainte-Justine, Université de Montréal, Montréal, Quebec Background: The Canadian Triage and Acuity Scale (CTAS) is a five-level triage tool constructed from a consensus of experts. Objectives: To evaluate the validity of the Canadian Triage and Acuity Scale (CTAS) for children visiting multiple paediatric Emergency Departments (ED) in Canada. Design/Methods: This was a retrospective study evaluating all children presenting to eight paediatric, university-affiliated EDs during one year in 2010-2011. In each setting, information regarding triage and
Paediatr Child Health Vol 17 Suppl A June/July 2012
disposition were prospectively registered by clerks in the ED database. Anonymized data were retrieved from the ED computerized database of each participating centre. In the absence of a gold standard for triage, hospitalisation, admission to intensive care unit (ICU), length of stay in the ED and proportion of patients who left without being seen by a physician (LWBS) were used as surrogate markers of severity. The primary outcome measure was the association between triage level (from one to five) and hospitalisation. The association between triage level and dichotomous outcomes was evaluated by a Chi-square test while a Student’s t test was used to evaluate the association between triage level and length of stay. It was estimated that the evaluation of all children visiting these EDs for a one year period would provide a minimum of 1,000 patients in each triage level and at least 10 events for outcomes having a proportion of 1% or more. Results: A total of 404,841 children visited the eight EDs during the study period. Pooled data demonstrated hospitalisation proportions of 59%, 30%, 10%, 2% and 0.5% for patients triaged at level 1, 2, 3, 4 and 5, respectively (p
