Comparison of manual statements from out-of-hospital trauma training programs and a national guideline on treatment of patients with severe and multiple injuries.

Abstract

Training programs help establish evidence-based knowledge in prehospital emergency care. This study aimed to compare manual statements from prehospital trauma training programs and evidence-based guidelines on treatment of patients with severe and multiple injuries. A systematic comparison with the primary endpoint of the highest grades of recommendation (GoR A, "must") of the current version of the German guidelines and recent recommendations of the prehospital trauma training programs International Trauma Life Support (ITLS), Prehospital Trauma Life Support (PHTLS), and Traumamanagement® (TM) based on their official textbooks was done. The recommendations were categorized as agreement or minor or major variation. The comparison was made using a rating system by experts who were blinded to the training programs. If the consensus strength of the experts was < 75%, affected statements were finalized in a Delphi procedure. Overall, 92 statements were compared. Fleiss-kappa of the first rating was 0.385 (p < 0.001, 95% CI: 0.376-0.393). Finally, comparable recommendations of the guideline with the training programs in principle agree with the statement of the guidelines were > 90% for all programs. The agreement with GoRA recommendations and each course program were 33.9%, 30.6%, and 35.5% (ITLS, PHTLS, and TM, respectively), p = 0.715. Despite small differences, the training programs showed high degrees of compliance with the guidelines and international agreement with some minor differences. Furthermore, the results did not allow any conclusions regarding the quality of the courses, the didactic methodology, and local adaptability. The practical implementation of the courses is probably even higher and closer to the guidelines.