title: Assessment of workload during pediatric trauma resuscitation.
abstract: BACKGROUND
  Trauma resuscitations are high-pressure, time-critical events during which health care providers form ad hoc teams to rapidly assess and treat injured patients. Trauma team members experience varying levels of workload during resuscitations resulting from the objective demands of their role-specific tasks, the circumstances surrounding the event, and their individual previous experiences. The goal of this study was to determine factors influencing workload experienced by trauma team members during pediatric trauma resuscitations.
  
  
  METHODS
  Workload was measured using the National Aeronautics and Space Administration Task Load Index (TLX). TLX surveys were administered to four trauma team roles: charge nurse, senior surgical resident (surgical coordinator), emergency medicine physician, and junior surgical resident or nurse practitioner (bedside clinician). A total of 217 surveys were completed. Univariate and multivariate statistical techniques were used to examine the relationship between workload and patient and clinical factors.
  
  
  RESULTS
  Bedside clinicians reported the highest total workload score (208.7), followed by emergency medicine physicians (156.3), surgical coordinators (144.1), and charge nurses (129.1). Workload was higher during higher-level activations (235.3), for events involving intubated patients (249.0), and for patients with an Injury Severity Score greater than 15 (230.4) (p, 0.001 for all). When controlling for potential confounders using multiple linear regression, workload was increased during higher level activations (79.0 points higher, p = 0.01) and events without previous notification (38.9 points higher, p = 0.03). Workload also remained significantly higher for the bedside clinician compared with the other three roles (p ≤ 0.005 for all).
  
  
  CONCLUSIONS
  Workload during pediatric trauma resuscitations differed by team role and was increased for higher-level activations and events without previous notification. This study demonstrates the validity of the TLX as a tool to measure workload in trauma resuscitation.
  
  
  METHODS
  Prognostic study, level II.
authors.affiliation: Division of Trauma and Burns, Children's National Medical Center, Washington, District of Columbia 20010, USA.
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Parsons
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Carter
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Waterhouse
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Sarcevic
authors.forename: Karen J
authors.initials: KJ
authors.lastname: O'Connell
authors.forename: Randall S
authors.initials: RS
authors.lastname: Burd
mesh_terms: D000328:Adult; D002648:Child; D019538:Health Care Surveys; D006801:Humans; D024802:Nurse's Role; D010348:Patient Care Team / Q000458:organization & administration*; D010564:Personnel, Hospital; D010819:Physician's Role; D012151:Resuscitation; D013647:Task Performance and Analysis; D014193:Trauma Centers / Q000458:organization & administration*; D014194:Traumatology / Q000458:organization & administration*; D016526:Workload