title: Comparison of sequential and simultaneous breathing and pulse check by healthcare professionals during simulated scenarios.
abstract: BACKGROUND
  Basic life support guidelines for healthcare professionals recommend a sequential breathing and carotid pulse check allowing up to 10 s for each assessment. Life support providers are sometimes taught to do a simultaneous assessment of breathing and pulse check for up to 10 s. It is not clear whether this assessment improves diagnostic accuracy.
  
  
  METHODS
  We recruited 119 healthcare professionals. The SIM-Man was used to develop 10 simulated cases scenarios. To assess performance, 89 participants did 10 simultaneous assessments followed by 10 sequential assessments, and 29 participants did the assessment techniques in reverse order. The primary outcome of the study was the number of correct diagnoses made with each assessment method.
  
  
  RESULTS
  There were more correct diagnoses with a sequential assessment; 48.2% (569 out of 1180) compared to 33.5% (395 out of 1180) for the simultaneous method. Only 26.3% (n=31) had more than five accurate diagnoses with a simultaneous assessment, compared to 44.1% (n=52) for sequential assessments. Those performing sequential assessment achieved a median score of 5/10 correct diagnoses compared to a median score of 2.5/10 for the simultaneous method (Wilcoxon Z=-4.63, p<0.001). Sensitivity for the pulse check was 99% for both assessments; specificity was 48.9% for a simultaneous assessment and 61.9% for the sequential approach. For breathing check, specificity, sensitivity and accuracy were also higher with the latter method (sensitivity 99.6%, specificity 70.6% and accuracy 88%)
  
  
  CONCLUSIONS
  A sequential assessment of breathing and pulse by healthcare professionals has greater diagnostic accuracy in simulated case scenarios.
authors.affiliation: Critical Care Nursing, Faculty of Health and Social Care, University of the West of England, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, UK. John.Albarran@uwe.ac.uk
authors.forename: John W
authors.initials: JW
authors.lastname: Albarran
authors.forename: Pam
authors.initials: P
authors.lastname: Moule
authors.forename: Mollie
authors.initials: M
authors.lastname: Gilchrist
authors.forename: Jasmeet
authors.initials: J
authors.lastname: Soar
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000379:methods*; D004521:Educational Measurement / Q000379:methods; D006323:Heart Arrest / Q000175:diagnosis*; D006801:Humans; D008348:Manikins; D011674:Pulse / Q000379:methods*; D012119:Respiration; D012680:Sensitivity and Specificity; D013997:Time Factors