Clinical outcomes of trauma tertiary surveys conducted by allied health and non-medical healthcare professionals: A scoping review.

Abstract

The trauma tertiary survey (TTS) is a critical step in identifying missed injuries following primary and secondary trauma assessment. The TTS is traditionally performed by junior medical professionals on a trauma unit. Despite this, increasing trauma caseloads have led to challenges with TTS adherence, missed injuries and overwork. This has prompted interest into delegating some of the TTS tasks to non-medical professionals, however the efficacy and safety of this approach is poorly characterised. A scoping review was conducted following Joanna Briggs Institute methodology following a comprehensive search in Medline, Embase, Emcare and CINAHL databases. The search encompassed terms related to TTS and non-medical professionals. Outcomes were related to safety and efficacy of TTS performed by non-medical professionals. Four observational studies involving trauma nurses (n = 3) and midlevel providers (n = 1) as non-medical providers of the TTS were included. Overall, there was evidence to suggest TTS performed by non-medical providers had similar missed injury detection rates and saved up to 1802 h of time for trauma residents. However, non-medical professionals demonstrated variable knowledge of TTS protocols, with gaps identified in training and experience. TTS performed by non-medical professionals appears feasible and yields comparable clinical outcomes to medical staff, with potential to alleviate medical workforce pressures. These findings are based on studies of high clinical heterogeneity and poor control for confounders.