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Region Hovedstaden - en del af Københavns Universitetshospital
E-pub ahead of print

Reliable and valid assessment of procedural skills in resuscitative endovascular balloon occlusion of the aorta (REBOA)

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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BACKGROUND: Valid and reliable assessment of skills is essential for improved and evidence-based training concepts. In a recent study, we presented a novel tool to assess procedural skills in resuscitative endovascular balloon occlusion of the aorta (REBOA), REBOA-RATE, based on international expert consensus. Although expert consensus is a strong foundation, the performance of REBOA-RATE has not been explored. The study aimed to examine the reliability and validity of REBOA-RATE.

METHODS: This was an experimental simulation-based study. We enrolled doctors with three levels of expertise to perform two REBOA-procedures in a simulated scenario of out-of-hospital cardiac arrest. Procedures were video-recorded, and videos were blinded and randomized. Three clinical experts independently rated all procedures using REBOA-RATE. Data were analyzed using Messick's framework for validity evidence, including generalizability analysis of reliability and determination of a pass/fail standard.

RESULTS: Forty-two doctors were enrolled: 16 novices, 13 anesthesiologists and 13 endovascular experts. They all performed two procedures, yielding 84 procedures and 252 ratings. REBOA-RATE showed high internal consistency (Cronbach's alpha = 0.95) and excellent interrater reliability (intraclass correlation coefficient = 0.97). Assessment using one rater and three procedures could ensure overall reliability suitable for high-stakes testing (G-coefficient > 0.80). Mean scores (SD) for the three groups in the second procedure were: Novices 32% (24%), anesthesiologists 55% (29%), endovascular experts 93% (4%), p < 0.001. The pass/fail standard was set at 81%, which all experts but no novices passed.

CONCLUSION: Data strongly support the reliability and validity of REBOA-RATE, which successfully discriminated between all experience levels. REBOA-RATE requires minimal instruction, and one rater is sufficient for reliable assessment. Together, these are strong arguments for the use of REBOA-RATE to assess REBOA skills, allowing for competency-based training and certification concepts.

LEVEL OF EVIDENCE: Level V ('Diagnostic' test, no or poor gold standard).

OriginalsprogEngelsk
TidsskriftThe journal of trauma and acute care surgery
Sider (fra-til)e-pub
ISSN2163-0755
DOI
StatusE-pub ahead of print - 2 jul. 2021

ID: 66793201