title: Development of a Burn Escharotomy Assessment Tool: A Pilot Study.
abstract: Severe burn injuries can require escharotomies which are urgent, infrequent, and relatively high-risk procedures necessary to preserve limb perfusion and sometimes ventilation. The American Burn Association Advanced Burn Life Support© course educates surgeons and emergency providers about escharotomy incisions but lacks a biomimetic trainer to demonstrate, practice, or provide assessment. The goal was to build an affordable biomimetic trainer with discrete points of failure and pilot a validation study. Fellowship-trained burn and plastic surgeons worked with special effect artists and anatomists to develop a biomimetic trainer with three discrete points of failure: median or ulnar nerve injury, fasciotomy, and failure to check distal pulse. Participants were divided between experienced and inexperienced, survey pre- and post-procedure on a biomimetic model while being timed. The trainer total cost per participant was less than $35. Eighteen participants were involved in the study. The inexperienced (0-1 prior escharotomies performed) had significantly more violations at the discrete points of failure relative to more experienced participants (P = .036). Face validity was assessed with 100% of participants agreement that the model appeared similar to real life and was valuable in their training. Given the advancements in biomimetic models and the need to train surgeons in how to perform infrequent, emergent surgical procedures, an escharotomy trainer is needed today. The authors developed an affordable model with a successful pilot study demonstrating discrimination between experienced and inexperienced surgeons. Additional research is needed to increase the reliability and assessment metrics.
authors.affiliation: From the *Department of General Surgery, †Center for Applied Learning, Wake Forest Innovations, and ‡Department of Plastic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ur
authors.forename: James H
authors.initials: JH
authors.lastname: Holmes
authors.forename: James E
authors.initials: JE
authors.lastname: Johnson
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Molnar
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Carter
mesh_terms: D001134:Arm Injuries / Q000601:surgery*; D002056:Burns / Q000601:surgery*; D002983:Clinical Competence; D004521:Educational Measurement; D000071938:Fasciotomy; D006801:Humans; D010865:Pilot Projects; D000066908:Simulation Training / Q000592:standards*; D013518:Surgery, Plastic / Q000193:education*