Advertisement

PASS-A course in Pediatric Acute Surgical Support to build pediatric surgical emergencies capacity in developing countries

      Abstract

      Objectives

      The burden of pediatric trauma and emergency, including pediatric surgical emergencies in low middle income countries (LMIC) is high. The goal of Pediatric Acute Surgical Support (PASS) course is to prepare caregivers in LMIC for the acute management of life-threatening pediatric surgical emergencies. We aim to show the feasibility of its initial deployment.

      Methods

      PASS was developed in 2016 with LMIC faculty from a teaching children hospital CH. The course contents consisted of a mix of didactic materials for serious general neonatal and pediatric surgery modified PALS/ATLS, in-person multidisciplinary team-based skill stations, interactive clinical scenarios and simulated trauma cases. The course was subsequently revised and delivered to 92 learners in four classes of 2.5-days sessions at two CHs between 2017 and 2019. Learners’ demographics, written exams, team-based case performance, and post-course survey data were prospectively collected and retrospectively analyzed.

      Results

      Physician (60%) and nurse learners (40%) from pediatric critical care (36%), surgery (23%), emergency medicine (20%) and anesthesiology (9%) had 3.6 +/- 3.6 years of clinical practice; pre- and post-course written exam score of 55.4+/-15.5% vs 71.6+/-12.8%, team-based trauma scenario management 22.6 ± 7.8% vs 54.7 ± 16.6% and team-based dynamic scores 17+/- 10% vs 53.3+/- 15.5%, respectively (p<0.0001). Self-reported satisfaction scores were ≥ 95% for course method, level of difficulty, clinical applicability, and quality of instructors.

      Conclusion

      PASS is well-received by LMIC learners, with short-term improvement in knowledge-, team-based management of acute pediatric surgery emergencies; and has the potential to be a model of horizontal capacity building for pediatric surgery in LMIC.

      Level of evidence

      II

      Keywords

      Abbreviations:

      ATLS (advanced trauma life support), APLS (advanced pediatric life support), CH (children's hospital), HCMC (Ho Chi Minh City), IPSAC (international specialist alliance for the children of Vietnam), LMIC (low middle income countries), PALS (Pediatric Advanced Life Support), PASS (Pediatric Acute Surgical Support), VN (Vietnam)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kiragu A.W.
        • Dunlop S.J.
        • Mwarumba N.
        • et al.
        Pediatric trauma care in low resource settings: challenges, opportunities, and solutions.
        Front Pediatr. 2018; 6: 155https://doi.org/10.3389/fped.2018.00155
        • Li Q.
        • Alonge O.
        • Hyder A.A.
        Children and road traffic injuries: can't the world do better?.
        Arch Dis Child. 2016; 101: 1063-1070https://doi.org/10.1136/archdischild-2015-309586
        • Remick K.
        • Gausche-Hill M.
        • Joseph M.M.
        • et al.
        Pediatric readiness in the emergency department.
        Pediatrics. 2018; 142: e20182459https://doi.org/10.1542/peds.2018-2459
        • Keating E.M.
        • Price R.R.
        • Robison J.A.
        Paediatric trauma epidemic: a call to action.
        BMJ Paediatr Open. 2019; 3e000532https://doi.org/10.1136/bmjpo-2019-0005322
        • Lam N.N.
        • Dung N.T.
        First aid and initial management for childhood burns in Vietnam-an appeal for public and continuing medical education.
        Burns. 2008; 34: 67-70https://doi.org/10.1016/j.burns.2007.01.006
        • Sohail A.H.
        • Maan M.H.
        • Sachal M.
        • et al.
        Challenges of training and delivery of pediatric surgical services in developing economies: a perspective from Pakistan.
        BMC Pediatr. 2019; 19: 152https://doi.org/10.1186/s12887-019-1512
        • Quansah R.
        • Abantanga F.
        • Donkor P.
        Trauma training for nonorthopaedic doctors in low- and middle-income countries.
        Clin Orthop Relat Res. 2008; 466: 403-2412https://doi.org/10.1007/s11999-008-0401-6
        • Kadhum M.
        • Sinclair P.
        • Lavy C.
        Are primary trauma care (PTC) courses beneficial in low- and middle-income countries-a systematic review.
        Injury. 2020; 51: 136-141https://doi.org/10.1016/j.injury.2019.10.084
        • Foley G.
        • Timonen V.
        Using grounded theory method to capture and analyze health care experiences.
        Health Serv Res. 2015; 50: 1195-1210https://doi.org/10.1111/1475-6773.12275
        • Davidson G.H.
        • Maier R.V.
        • Arbabi S.
        • et al.
        Impact of operative intervention delay on pediatric trauma outcomes.
        J Trauma Acute Care Surg. 2012; 73: 162-167https://doi.org/10.1097/TA.0b013e31825699b4
        • Miraflor E.
        • Chuang K.
        • Miranda M.A.
        Timing is everything: delayed intubation is associated with increased mortality in initially stable trauma patients.
        J Surg Res. 2011; 170: 286-290https://doi.org/10.1016/j.jss.2011.03.044
        • Tien H.C.
        • Jung V.
        • Pinto R.
        • et al.
        Reducing time-to-treatment decreases mortality of trauma patients with acute subdural hematoma.
        Ann Surg. 2011; 253: 1178-1183https://doi.org/10.1097/SLA.0b013e318217e339
        • Luu N.H.
        • Nguyen L.V.
        • van der Wilt G.J.
        • et al.
        Motivation of university and non-university stakeholders to change medical education in Vietnam.
        BMC Med Educ. 2009; 9: 49https://doi.org/10.1186/1472-6920-9-49
        • Dickason R.M.
        • Cieo-Pena E.
        • Chisolm-Straker M.
        Primary trauma care curriculum: a qualitative analysis of impediments of improvement.
        Trauma. 2017; 19: 127-132https://doi.org/10.1177/1460408616675641
        • Kurdin A.
        • Caines A.
        • Boone D.
        • Furey A.
        TEAM: a low-cost alternative to ATLS for providing trauma care teaching in Haiti.
        J Surg Educ. 2018; 75: 377-382https://doi.org/10.1016/j.jsurg.2017.08.010
        • Ullrich S.J.
        • Kilyewala C.
        • Lipnick M.S.
        • et al.
        Design, implementation and long-term follow-up of a context specific trauma training course in Uganda: lessons learned and future directions.
        Am J Surg. 2020; 219: 263-268https://doi.org/10.1016/j.amjsurg.2019.10.048
        • Pinkham L.
        • Botelho F.
        • Khan M.
        • et al.
        Teaching trauma in resource-limited settings: a scoping review of pediatric trauma courses.
        World J Surg. 2022; https://doi.org/10.1007/s00268-021-06419-3