Optimizing Pediatric Trauma Team Performance Through Interdisciplinary Trauma Simulation and Feedback From Trauma Code Video Analysis

Lea C Dikranian; Katherine Oag; Lisa Vitale; Mariah Malaniak; Ronald Thomas; Kelly Levasseur

doi:10.1097/PEC.0000000000003492

Optimizing Pediatric Trauma Team Performance Through Interdisciplinary Trauma Simulation and Feedback From Trauma Code Video Analysis

Pediatr Emerg Care. 2025 Oct 3. doi: 10.1097/PEC.0000000000003492. Online ahead of print.

Authors

Lea C Dikranian¹, Katherine Oag², Lisa Vitale², Mariah Malaniak², Ronald Thomas³, Kelly Levasseur^{1

3}

Affiliations

¹ Department of Pediatric Emergency Medicine.
² Department of Pediatric Trauma Surgery, Children's Hospital of Michigan.
³ Department of Pediatrics, College of Medicine.

PMID: 41041905
DOI: 10.1097/PEC.0000000000003492

Abstract

Introduction: Trauma is a leading cause of pediatric emergency visits, yet training often underemphasizes nontechnical skills (NOTECHS). Simulation-based training can improve these skills, and targeted video review (TVR) may further enhance debriefings by enabling precise, case-based feedback. This study evaluated the combined impact of multidisciplinary, simulation-based training and TVR on technical performance and NOTECHS during pediatric trauma resuscitations.

Methods: This prospective educational quality improvement study was conducted at a level 1 pediatric trauma center from February 2023 to July 2023. Multidisciplinary teams participated in in situ pediatric trauma simulations followed by structured debriefings incorporating TVR. Video reviews of preintervention and postintervention trauma activations (n = 76) assessed changes in team behavior and clinical metrics, including time-to-vitals, imaging, emergency department (ED) length of stay (LOS), and time-to-operating room (OR). Trauma performance was evaluated using the Trauma Team Evaluation Tool and T-NOTECHS.

Results: Seventy-six trauma activations (21 preintervention, 55 postintervention) were reviewed. Postintervention, the proportion of cases without an identified team leader decreased (33% to 9.1%), and those with a defined disposition plan increased (66.7% to 100%). Overall team performance improved (6.52 to 7.60/10; P < 0.001), with significant gains in communication and situational awareness ( P = 0.012 and P = 0.033, respectively). Time-to-vitals decreased significantly ( P = 0.027); while imaging, ED LOS, and time-to-OR showed nonsignificant changes.

Conclusions: Simulation-based interdisciplinary training, paired with TVR improved teamwork, communication, and decision-making in pediatric trauma resuscitations. This approach reinforced protocol adherence and supported quality improvement. While effects on patient outcomes remain uncertain, these findings support simulation and TVR as strategies to enhance performance in high-acuity settings.

Keywords: , pediatrics; non-technical skills; simulation; trauma.