Appl Clin Inform 2023; 14(04): 714-724
DOI: 10.1055/s-0043-1771396
Research Article

Design and Development of an Objective Evaluation System for a Web-Based Simulator for Trauma Management

1   Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
,
Luis Castañeda López
1   Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
,
Fernando Monforte-Escobar
2   SAMUR – Protección Civil, SAMUR-PC, Madrid, Spain
,
Rubén Quintero Mínguez
3   Emergency Services SUMMA 112, Madrid, Spain
,
Manuel Quintana-Díaz
4   Servicio de Medicina Intensiva, Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
,
Álvaro Gutiérrez
1   Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
› Author Affiliations
Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Abstract

Background Trauma injuries are one of the main leading causes of death in the world. Training with guidelines and protocols is adequate to provide a fast and efficient treatment to patients that suffer a trauma injury.

Objectives This study aimed to evaluate deviations from a set protocol, a new set of metrics has been proposed and tested in a pilot study.

Methods The participants were final-year students from the Universidad Autónoma de Madrid and first-year medical residents from the Hospital Universitario La Paz. They were asked to train four trauma scenarios with a web-based simulator for 2 weeks. A test was performed pre-training and another one post-training to evaluate the evolution of the treatment to those four trauma scenarios considering a predefined trauma protocol and based on the new set of metrics. The scenarios were pelvic and lower limb traumas in a hospital and in a prehospital setting, which allow them to learn and assess different trauma protocols.

Results The results show that, in general, there is an improvement of the new metrics after training with the simulator.

Conclusion These new metrics provide comprehensive information for both trainers and trainees. For trainers, the evaluation of the simulation is automated and contains all relevant information to assess the performance of the trainee. And for trainees, it provides valuable real-time information that could support the trauma management learning process.

Protection of Human and Animal Subjects

This study did not involve human and/or animal subjects as the research objective.


Authors' Contributions

All authors whose names appear on the submission, (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.




Publication History

Received: 25 April 2023

Accepted: 15 June 2023

Article published online:
06 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Ruchholtz S, Nast-Kolb D, Waydhas C, Betz P, Schweiberer L. Early mortality in polytrauma. A critical analysis of preventable errors [in German]. Unfallchirurg 1994; 97 (06) 285-291
  • 2 Ruchholtz S, Waydhas C, Aufmkolk M. et al. Interdisciplinary quality management in the treatment of severely injured patients. Validation of a QM system for the diagnostic and therapeutic process in early clinical management [in German]. Unfallchirurg 2001; 104 (10) 927-937
  • 3 Bouillon B, Kanz KG, Lackner CK, Mutschler W, Sturm J. The importance of Advanced Trauma Life Support (ATLS) in the emergency room [in German]. Unfallchirurg 2004; 107 (10) 844-850
  • 4 Bernhard M, Becker TK, Nowe T. et al. Introduction of a treatment algorithm can improve the early management of emergency patients in the resuscitation room. Resuscitation 2007; 73 (03) 362-373
  • 5 Hilbert P, zur Nieden K, Hofmann GO, Hoeller I, Koch R, Stuttmann R. New aspects in the emergency room management of critically injured patients: a multi-slice CT-oriented care algorithm. Injury 2007; 38 (05) 552-558
  • 6 Kanz KG, Körner M, Linsenmaier U. et al. Priority-oriented shock trauma room management with the integration of multiple-view spiral computed tomography [in German]. Unfallchirurg 2004; 107 (10) 937-944
  • 7 Wurmb TE, Frühwald P, Knuepffer J. et al. Application of standard operating procedures accelerates the process of trauma care in patients with multiple injuries. Eur J Emerg Med 2008; 15 (06) 311-317
  • 8 American College of Surgeons Committee on Trauma. Advanced Trauma Life Support. 10th ed.,. Chicago, IL: American College of Surgeons; 2018
  • 9 Sturm JA, Lackner CK, Bouillon B, Seekamp A, Mutschler WE. Advanced Trauma Life Support (ATLS) [in German]. Unfallchirurg 2002; 105 (11) 1027-1032
  • 10 van Olden GD, Meeuwis JD, Bolhuis HW, Boxma H, Goris RJ. Advanced trauma life support study: quality of diagnostic and therapeutic procedures. J Trauma 2004; 57 (02) 381-384
  • 11 van Olden GD, Meeuwis JD, Bolhuis HW, Boxma H, Goris RJ. Clinical impact of advanced trauma life support. Am J Emerg Med 2004; 22 (07) 522-525
  • 12 Spain DA, McIlvoy LH, Fix SE. et al. Effect of a clinical pathway for severe traumatic brain injury on resource utilization. J Trauma 1998; 45 (01) 101-104 , discussion 104–105
  • 13 Pritts TA, Nussbaum MS, Flesch LV, Fegelman EJ, Parikh AA, Fischer JE. Implementation of a clinical pathway decreases length of stay and cost for bowel resection. Ann Surg 1999; 230 (05) 728-733
  • 14 Campbell H, Hotchkiss R, Bradshaw N, Porteous M. Integrated care pathways. BMJ 1998; 316 (7125) 133-137
  • 15 Campion FX, Rosenblatt MS. Quality assurance and medical outcomes in the era of cost containment. Surg Clin North Am 1996; 76 (01) 139-159
  • 16 Curtis K, Asha SE, Unsworth A. et al. ChIP: an early activation protocol for isolated blunt chest injury improves outcomes, a retrospective cohort study. Australas Emerg Nurs J 2016; 19 (03) 127-132
  • 17 Carrie C, Stecken L, Cayrol E. et al. Bundle of care for blunt chest trauma patients improves analgesia but increases rates of intensive care unit admission: a retrospective case-control study. Anaesth Crit Care Pain Med 2018; 37 (03) 211-215
  • 18 Todd SR, McNally MM, Holcomb JB. et al. A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. Am J Surg 2006; 192 (06) 806-811
  • 19 Nyland BA, Spilman SK, Halub ME. et al. A preventative respiratory protocol to identify trauma subjects at risk for respiratory compromise on a general in-patient ward. Respir Care 2016; 61 (12) 1580-1587
  • 20 Sahr SM, Webb ML, Renner CH, Sokol RK, Swegle JR. Implementation of a rib fracture triage protocol in elderly trauma patients. J Trauma Nurs 2013; 20 (04) 172-175 , quiz 176–177
  • 21 Menditto VG, Gabrielli B, Marcosignori M. et al. A management of blunt thoracic trauma in an emergency department observation unit: pre-post observational study. J Trauma Acute Care Surg 2012; 72 (01) 222-228
  • 22 Morrison CA, Lee TC, Wall Jr MJ, Carrick MM. Use of a trauma service clinical pathway to improve patient outcomes for retained traumatic hemothorax. World J Surg 2009; 33 (09) 1851-1856
  • 23 Frederickson TA, Renner CH, Swegle JR, Sahr SM. The cumulative effect of multiple critical care protocols on length of stay in a geriatric trauma population. J Intensive Care Med 2013; 28 (01) 58-66
  • 24 Dunham CM, Bosse MJ, Clancy TV. et al; EAST Practice Management Guidelines Work Group. Practice management guidelines for the optimal timing of long-bone fracture stabilization in polytrauma patients: the EAST Practice Management Guidelines Work Group. J Trauma 2001; 50 (05) 958-967
  • 25 Jacobs DG, Plaisier BR, Barie PS. et al; EAST Practice Management Guidelines Work Group. Practice management guidelines for geriatric trauma: the EAST Practice Management Guidelines Work Group. J Trauma 2003; 54 (02) 391-416
  • 26 Latini EE. Trauma critical pathways: a care delivery system that works. Crit Care Nurs Q 1996; 19 (01) 83-87
  • 27 Wilson S, Bin J, Sesperez J, Seger M, Sugrue M. Clinical pathways–can they be used in trauma care. An analysis of their ability to fit the patient. Injury 2001; 32 (07) 525-532
  • 28 Friesdorf W, Konichezky S, Gross-Alltag F, Geva D, Nathe M, Schraag S. Decision making in high dependency environments–can we learn from modern industrial management models?. Int J Clin Monit Comput 1994; 11 (01) 11-17
  • 29 Baker E, Woolley A, Xyrichis A, Norton C, Hopkins P, Lee G. How does the implementation of a patient pathway-based intervention in the acute care of blunt thoracic injury impact on patient outcomes? A systematic review of the literature. Injury 2020; 51 (08) 1733-1743
  • 30 Unsworth A, Curtis K, Asha SE. Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery. Scand J Trauma Resusc Emerg Med 2015; 23: 17
  • 31 Kourouche S, Buckley T, Munroe B, Curtis K. Development of a blunt chest injury care bundle: an integrative review. Injury 2018; 49 (06) 1008-1023
  • 32 Roberts HC, Pickering RM, Onslow E. et al. The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study. Age Ageing 2004; 33 (02) 178-184
  • 33 Kwan J, Hand P, Dennis M, Sandercock P. Effects of introducing an integrated care pathway in an acute stroke unit. Age Ageing 2004; 33 (04) 362-367
  • 34 Vanhaecht K, De Witte K, Panella M, Sermeus W. Do pathways lead to better organized care processes?. J Eval Clin Pract 2009; 15 (05) 782-788
  • 35 Evans-Lacko S, Jarrett M, McCrone P, Thornicroft G. Facilitators and barriers to implementing clinical care pathways. BMC Health Serv Res 2010; 10: 182
  • 36 Hipp R, Abel E, Weber RJ. A primer on clinical pathways. Hosp Pharm 2016; 51 (05) 416-421
  • 37 Helbig K, Rmer M, Mellouli T. A clinical pathway mining approach to enable scheduling of hospital relocations and treatment services. In: Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics). Switzerland: Springer; 2015. :9253: 242-250
  • 38 Michalowski W, Wilk S, Thijssen A, Li M. Using a Bayesian belief network model to categorize length of stay for radical prostatectomy patients. Health Care Manage Sci 2006; 9 (04) 341-348
  • 39 Konrad R, Tulu B, Lawley M. Monitoring adherence to evidence-based practices: a method to utilize HL7 messages from hospital information systems. Appl Clin Inform 2013; 4 (01) 126-143
  • 40 Huang Z, Dong W, Bath P, Ji L, Duan H. On mining latent treatment patterns from electronic medical records. Data Min Knowl Discov 2015; 29 (04) 914-949
  • 41 Bahou N, Fenwick C, Anderson G, van der Meer R, Vassalos T. Modeling the critical care pathway for cardiothoracic surgery. Health Care Manage Sci 2018; 21 (02) 192-203
  • 42 Mans R, Schonenberg H, Leonardi G. et al. Process mining techniques: an application to stroke care. Stud Health Technol Inform 2008; 136: 573-578
  • 43 Ben Othman S, Zgaya H, Hammadi S, Quilliot A, Martinot A, Renard J-M. Agents endowed with uncertainty management behaviors to solve a multiskill healthcare task scheduling. J Biomed Inform 2016; 64: 25-43
  • 44 Joranger P, Nesbakken A, Hoff G, Sorbye H, Oshaug A, Aas E. Modeling and validating the cost and clinical pathway of colorectal cancer. Med Decis Making 2015; 35 (02) 255-265
  • 45 Sesperez J, Wilson S, Jalaludin B, Seger M, Sugrue M. Trauma case management and clinical pathways: prospective evaluation of their effect on selected patient outcomes in five key trauma conditions. J Trauma 2001; 50 (04) 643-649
  • 46 Moore GF, Audrey S, Barker M. et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ 2015; 350: h1258
  • 47 Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud 2013; 50 (05) 587-592
  • 48 O'Cathain A, Croot L, Duncan E. et al. Guidance on how to develop complex interventions to improve health and healthcare. BMJ Open 2019; 9 (08) e029954
  • 49 Boyko EJ. Observational research–opportunities and limitations. J Diabetes Complications 2013; 27 (06) 642-648
  • 50 Aspland E, Gartner D, Harper P. Clinical pathway modelling: a literature review. Health Syst (Basingstoke) 2019; 10 (01) 1-23
  • 51 Abelsson A, Rystedt I, Suserud BO, Lindwall L. Learning by simulation in prehospital emergency care - an integrative literature review. Scand J Caring Sci 2016; 30 (02) 234-240
  • 52 Knudson MM, Khaw L, Bullard MK. et al. Trauma training in simulation: translating skills from SIM time to real time. J Trauma 2008; 64 (02) 255-263 , discussion 263–264
  • 53 Patel D, Hawkins J, Chehab LZ. et al. Developing virtual reality trauma training experiences using 360-degree video: tutorial. J Med Internet Res 2020; 22 (12) e22420
  • 54 Cohen D, Sevdalis N, Taylor D. et al. Emergency preparedness in the 21st century: training and preparation modules in virtual environments. Resuscitation 2013; 84 (01) 78-84
  • 55 Fleiszer D, Hoover ML, Posel N, Razek T, Bergman S. Development and validation of a tool to evaluate the evolution of clinical reasoning in trauma using virtual patients. J Surg Educ 2018; 75 (03) 779-786
  • 56 Taylor D, Patel V, Cohen D. et al. Single and multi-user virtual patient design in the virtual world. Stud Health Technol Inform 2011; 163 (01) 650-652
  • 57 Wise EM, McIvor WR, Mangione MP. Assessing student usage, perception, and the utility of a Web-based simulation in a third-year medical school clerkship. J Clin Anesth 2016; 33: 5-13
  • 58 Murray D, Boulet J, Ziv A, Woodhouse J, Kras J, McAllister J. An acute care skills evaluation for graduating medical students: a pilot study using clinical simulation. Med Educ 2002; 36 (09) 833-841
  • 59 Hayes KA, Lehmann CU. The interactive patient: a multimedia interactive educational tool on the World Wide Web. MD Comput 1996; 13 (04) 330-334
  • 60 Aspland E, Harper PR, Gartner D, Webb P, Barrett-Lee P. Modified Needleman-Wunsch algorithm for clinical pathway clustering. J Biomed Inform 2021; 115: 103668
  • 61 Needleman SB, Wunsch CD. A general method applicable to the search for similarities in the amino acid sequence of two proteins. J Mol Biol 1970; 48 (03) 443-453
  • 62 Larraga-García B, Castañeda López L, Rubio Bolívar FJ, Quintana-Díaz M, Gutiérrez Á. Design and development of an interactive web-based simulator for trauma training: a pilot study. J Med Syst 2021; 45 (11) 96
  • 63 Lam F, Longnecker M. A modified Wilcoxon rank sum test for paired data. Biometrika 1983; 70 (02) 510-513