पल्मोनरी एवं श्वसन चिकित्सा

Development and Validation of a Performance Assessment Scale for Chest Tube Insertion in Traumatic Pneumothorax

Abstract

Aiham Ghazali, Alexandre Léger, Franck Petitpas, Youcef Guéchi, Amélie Boureau-Voultoury and Denis Oriot \r\n

Background: Insertion of a chest tube is a potentially dangerous procedure in cases of pneumothorax. Different chest tube insertion techniques have been described. In a trauma setting, surgical approach should be aimed at diminishing the number of complications. Even though simulation-based training has facilitated enhanced performance of this procedure, no assessment scale has been published to date.

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Objective: The objective of this study was to design and validate a performance assessment scale for surgical chest tube insertion in traumatic pneumothorax.

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Methods: The scale content (8 steps, 20 items with a total over 20) was designed by three experts on the basis of international recommendations and Advanced Trauma Life Support courses, and adjusted after testing on 9 senior physicians. 104 participants were included for psychometric analysis of the scale. The model employed was a previously developed surgical chest tube insertion simulator. Assessment was carried out by two independent observers chosen from among a group of 6.

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Results: Mean score of participants registered to the university course was 13.51 ± 3.36 (n=104). Cronbach alpha was 0.747 and intraclass coefficient was 0.966 reflecting respectively good coherence and excellent interobserver reproducibility. The score was able to conclusively discriminate between success and failure of insertion (p<0.0001). Both assessment scores and success rates were found to correlate with level of training (Rho=0.76 and 0.66 respectively, p<0.0001).

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Conclusion: This performance assessment scale was found to be consistent and reliable for surgical chest tube insertion procedure in traumatic pneumothorax. It may constitute a useful tool for assessment of the performance of participants in simulation-based education setting.

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