A priority driven ABC approach to the emergency management of high energy pelvic trauma improves decision making in simulated patient scenarios

INTRODUCTION: An ABC priority driven approach to the management of high energy pelvic injuries has been developed and applied as a teaching tool. A prospective study assessed whether trainees taught this ABC aide memoire gave better priority driven care in simulated patient scenarios. They were compared directly to colleagues undergoing the same pelvic training but without reference to the ABC concept.

METHODS: Orthopaedic trainees were formally assessed by viva scenario upon their pelvic trauma management 6 weeks after a pelvic trauma teaching event. Trainees all received standard pelvic trauma teaching but were randomised into two groups. One group alone had an introduction to the ABC algorithm. Inclusion criteria were trainees belonging to the same deanery teaching group with similar levels of training and experience in pelvic trauma. Those completing a pelvic trauma post or teaching in pelvic trauma were excluded.

RESULTS: There were 20 trainees included and three scenarios giving 60 scores. The mean year of training or the number of pelvic trauma cases experienced did not differ significantly between the groups (p=0.426 and p=0.347). The ABC teaching concept yielded significant improvements in several aspects: coagulopathy assessment and management (p=<0.001); urological injury (p=0.047), appropriate prioritisation (p=0.006) and bowel injury/open fracture assessment (p=0.007). A poorer response was seen in CT assessment (p=0.004).

DISCUSSION AND CONCLUSION: The ABC priority driven approach to pelvic trauma management provides structure when decision making. This method improves clinician's recall, prioritisation and potentially clinical outcomes.