Abstract
Study objectiveTo use cognitive task analysis (CTA) to elicit experts’ knowledge and outline their clinical decision-making process for the management of pediatric blunt abdominal injury.MethodsThis was a mixed-methods study involving in-depth interviews and a focus group with local experts followed by a review survey with a panel of experts from numerous pediatric trauma centers across the United States. All experts specialized in pediatric emergency medicine and pediatric trauma surgery.ResultsCommon themes that emerged during seven in-depth interviews with local experts included: clinical management, clinical reasoning, situational awareness, potential errors/novice traps, knowledge and skills, communication, and quality indicators. A total of 17 external experts responded to the survey for a response rate of 77%. External experts indicated that the information outlined in the CTA was complete and accurate, and provided valuable insights into the discrepancies that were unresolved during the focus group with local experts. They indicated agreement with potential errors/novice traps reported by local experts. Specifically, they indicated that the failure in coordinating team activities, maintaining the big picture, and performing a thorough physical examination posed serious threats to novices when managing a child with blunt abdominal trauma.ConclusionCTA may be applied to pediatric management of blunt abdominal injury to identify critical steps and potential errors to serve as a framework for education in pediatric emergency medicine and pediatric trauma surgery. Future studies may apply CTA to other types of traumatic injuries and/or involve an interdisciplinary approach.
Highlights
BackgroundInjury is the leading cause of death in children from ages 1 to 18 years [1]
External experts indicated that the information outlined in the cognitive task analysis (CTA) was complete and accurate, and provided valuable insights into the discrepancies that were unresolved during the focus group with local experts
They indicated that the failure in coordinating team activities, maintaining the big picture, and performing a thorough physical examination posed serious threats to novices when managing a child with blunt abdominal trauma
Summary
BackgroundInjury is the leading cause of death in children from ages 1 to 18 years [1]. There are numerous other causes of increased heart rate in children, such as pain or anxiety, which confound decision-making. Treatments and interventions require child-specific decisions be made, in terms of equipment, medication dosage, and definitive care. To remedy this situation, practitioners need an avenue to learn about the management of pediatric trauma patients, to improve their decision-making skills and to reduce the risk of potential errors. Training focused on modeling expert performance can help enhance a practitioner’s ability to manage emergent trauma cases. For this complex task, observing expert behaviors is not enough. Decision-making for management of traumatic patients is second-nature for experts, and it may be challenging for them to provide a detailed account of their thought process
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