Management of splenic injury in children and young adults: a survey of surgeons investigating factors responsible for variations in care using the Theoretical Domains Framework
Notice bibliographique
Résumé
STRUCTURED ABSTRACT Objective: To identify differences in practice and behavioural drivers in adult and paediatric surgeons related to the management of splenic injury in children and young people. Background: Despite the existence of guidelines, there are variations in the care of children with splenic injuries. There are no specific guidelines for the care of young adults, who may be managed according to either paediatric or adult practices. The drivers of variation in trauma management between adult and paediatric surgeons have not been examined through an implementation science lens. Methods: The COM-B model of behaviour and theoretical domains framework were used to construct a survey which was delivered to a cross-section of adult general surgeons and paediatric surgeons working in public hospitals throughout NSW, Australia. The capability, opportunity, and motivation for management decisions were analysed. Outcome variables were compared between the practitioner groups. Statistical significance was set at p < 0.05. Results: Eighty (26.4%) responses met the inclusion criteria. Significant differences between adult and paediatric surgeons were identified in terms of: capability (surgeon training and experience); opportunity (hospital, personnel, and resources); and motivation (comfort with splenic injury care at different ages). In managing splenic injury, pediatric surgeons tended to follow pediatric guidelines while adult surgeons followed adult guidelines, making some adjustments for age. All agreed guidelines had the potential to improve care. Conclusions: This study identified several behavioural drivers for observed variations in the care of splenic injury in children and young adults. The results indicate that contextually relevant guidelines for managing splenic injury in children and young people across any setting may be needed to reduce disparities in care. These should be underpinned by interventions designed to further address the drivers of surgeon behaviour to optimise uptake. Furthermore, splenic injury care is a clinical indicator of the quality of trauma care more broadly. Addressing variation in its care has the potential to translate to other trauma system improvements. HIGHLIGHTS Unwarranted variations in splenic injury management have been reported. This is the first examination of surgeon behaviour in the provision of trauma care through an implementation science lens. Differences in the capability, opportunity, and motivation of surgeons in providing evidence-based care to children and young adults with splenic injury were found. Contextually relevant guidelines, underpinned by supporting interventions addressing these behavioural drivers, are needed to reduce disparities in care.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».