Critical Review: Technology for Trauma

This treatise critically appraises a published research paper, specifically relating to trauma in the pre hospital environment. I have utilised the CASP tool (Critical Appraisal Skills Programme 2006) to aid with the composition. The CASP tool has been adapted and used in synthesis of qualitative research (Pope, Mays and Popay, 2007).The label of the chosen research paper is ‘Technology for trauma: testing the validity of a smartphone app for pre-hospital clinicians’

The title of the paper clearly elucidates the research, but is a little too extensive in its approach yet the subject matter is clearly expounded without using extraneous words or predisposing the outcomes discovered. The reader is able to summise the aim of the research from the provided title, without losing focus, and the key words act as highlights to the proposed research goal and the main body of text. 

The article opens with an abstract, as is normal practice, in which it elucidates a brief introduction, the methods used, the results and a conclusion. It also pithily articulates an explanation behind the positive predictive value (PPV) and that the PPV was used with each tool. Cassens (1992) discusses that the Positive Predictive Value usually is expressed as a percentage. The pronouncements within the work are indistinguishable and everything avowed can be found within the main body of work. 

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The author evidently recognises within the opening abstract, and the main body of text, all the predetermined research aims. Because the author has used vibrant aims, they are able to clearly interpret the results and discussions, thus facilitating the script to flow fluently.

The author has kept the aims brief and pertinent, and they have sculptured the brief passage to use non-technical language with having used only 1 abbreviation; however this has previously been explained in the content and the concept vision is also addressed clearly within the aims.

The appraisal can be simply understood due to the author using a concise aim which is coherent and intelligible; this then gives the research a clear focal point. The background information that is embraced within the study intimates that the topic has been thoroughly researched and the construction of the study modes have been aided in a comprehensive and robust style.

The research exhibited uses qualitative methods which is apposite for this style of research as the author is attempting to highlight the stances, occurrences and emotions of those involved, concerning the appropriateness of an app based tool compared to the traditional paper based tool for prehospital clinicians within a trauma setting.  The researcher uses statistics to highlight the comparable successes of the two tools, but also uses participants’ responses and their subjective proficiencies surrounding the targeted review. Qualitative research approaches the essence of societal marvels, allowing individuals the prospect to comprehend actions of personages and the formula behind the behaviours. Qualitative research is about immersing oneself in a scene and trying to make sense of it (Tracey 2013)

Grounded theory, as well as thematic analysis, is flaunted within the article, and these can both be used to develop theories which can be transitioned into working practice. Grounded theory is one of the most popular research designs in the world (Birks & Mills, 2015) and helps create hypothesis, and within this research piece a concept has been generated in the form of comparable data from two opposing sides. Thematic analysis is a translator of those speaking the language of qualitative analysis (Boyatzis, 2009). As much as there is already a concrete theory in place to the suitability and functionality of a pre hospital trauma tool, new theories are generated into the feasibility of changing to a new evolving electronic trauma tool. Grounded theory can at times be ambiguous but this study has applied the grounded theory correctly due to using current research to guide and direct the study.

As much as Grounded theory has evidently been used within the format, the author has annulled to express the way in which it has been applied or integrated it into the research. The exact method of exploration has not been alluded to by the author in the main workings of the article and it has not been expelled as to how the information and findings have been dissolved into the expose

The article is well set out and the design and make-up of the piece allows the reader to navigate it with ease and it permits the body of text to be simply read and transversed negating any hardship. The background and results are dissected intermittently with examples of clinical cases along with relevant diagrammatic representation and data in easily comprehendible graphs and numerical tables.

A total of 50 participants were selected and these were made up of paramedics, ambulance technicians and emergency care assistants. The majority were paramedics, 64% (n = 32), with the remainder being ambulance technicians (n = 10) and emergency care assistants (n = 8). The cohort were recruited following organisational approval to conduct the study with permission to recruit during regular team training sessions being granted by the ambulance trusts clinical review group. Staff were invited to participate, it was not mandatory and none declined.

Although this is one of the most convenient ways of recruitment for the researchers, it may mean that there is a risk that the respondents are not the most appropriate to the task itself. As much as the article states that the participants’ experience of using the paper based tool was recorded, the article negates to express the results of these records. This is a fundamental flaw as it may have massive impact on the ease with which the tools are used, and with this comes the fact that it may muddy the results that each individual is able to ascertain or experience. The conclusions may be diverse for less experienced clinicians or those who have experienced a different training strategy and experience. There is also no explanation as to why the clinicians chose to participate in the study, and what made the trial so tantalising for each one in turn

Although all volunteers were conscripted from a viable source, it could be visioned to be difficult to understand how all enlisted were experienced to an adequate level or same level as their peers, and as much as the cohort is relatively small, there may be some anomalies within the research. One way to boycott the theory that some participants may be sub-standard would be to use a different sampling method to the convenience sampling, which it appears, has been used in this process.

Convenience Sampling is a robust method of sampling and commonly used in large scale studies, therefore, to use it on a study where there were only 50 participants seems outlandish to say the least

The researcher discloses that the data was collected with the administration of scenarios taking place in four locations on five occasions. Demographic information relating to the participants clinical grade or role was also collected, along with their experience of using the Trauma Unit Bypass (TUB) tool in practice along with smartphone use.

The questionnaires and scenarios were explained to each group together, this is not a robust method as some people may conform to others responses when within a group. It also does not detail how structured the group exercise was, but using a face to face method would allow the interviewer to observe non-verbal communication techniques, as well as the reactions being exuded.

The group were asked to use their allocated tool to recommend a hospital, Trauma Unit (TU) or Major Trauma Centre (MTC) for each case, based on the information provided. The answers for each case were then compared against those noted by the panel and graded as ‘matched’ if they were the same, or ‘not matched’ if they did not concur. The author explains that the panel is multi-disciplinary and is built up of experienced clinicians, including Emergency Department (ED) doctors, senior nurses and paramedics, with each profession being represented by two clinicians from each discipline.

The sample consisted of splitting the group into 2 factions, determined by using an alternate numbering technique around the room; participants were assigned to one of the 2 groups; the ‘paper’ group and the ‘app’ group. Those that were randomised to the ‘app’ group were provided with an iPhone or iPad on which to use the app. The author notes that the participants experience of using the TUB tool in practice and smartphone use was also recorded, but it is not noted what the results of this are. It would have been useful to know these results as this could have either a positive or indeed a negative impact on the trial and the conclusions. The article doesn’t discuss if the new ‘app’ tool or the scenarios were able to be discussed prior to replying, this could cause the results to be inaccurate if it was the case, and some responses may be impelled by other professionals with different experiences 

The fact that only ambulance clinicians were interviewed could lead to the data set result being biased. The researcher has not remarked on the rationale for using the methods they used, within the article. Equipping the logic could help ensure validity in the study development and outcomes.

Throughout the article, no reference is made to the researchers own profession, thus negating if this could cause any bias. Researchers are said to be prejudiced if a dispassionate tactic to exploration is not expended.

It cannot be assured that ethical issues have been cogitated during the study as there is no allusion to this subject. There is no defence for the ethical issues not to be taken into consideration vis-à-vis the participants’ welfare, although it can be presumed that informed consent was gained from each respondent as they all volunteered for the research.

Throughout the study, the results were amply explored by means of thematic analysis.  By using thematic analysis the retorts from the partakers were used to find chronic themes and then placing the responses in specific nodes. As much as it is clear from the main body of the article that thematic analysis has been used, the author does not make any direct reference to the method. The author also negates the reason as to why specific examples are published and not others. The author has however decorated the article with numerous of varying examples in differing guises. This is really supportive and helps the reader to navigate the results in a timely and productive manner

The author also discusses that there are limitations within the study and in particular the data collection. It is good that the author has been transparent, but they don’t detail if they have tried to generate a solution to the limitation. They detail that undeniable demographic data was not amassed from the participants and it was also not viable to make an affinity between the testing groups in terms of their age, gender, experience or other factors that may influence their use of the tool. The fact that the study did not measure the time it took to reach a decision on transport destination for trauma patients in comparison to the paper based tool is also discussed by the author. They do recognise that this is omitted and they have recommended that this could be an area for additional investigation, particularly pertinent when managing time critical patients.

There is a clear consensus that the smartphone app performed at least as well as the paper based version of the Wessex trauma network TUB tool. It was therefore considered safe to release a general version of the app which is now being used within the network.

In conclusion, the article is well devised and expressive. It has evocative results and the aims and discussion are constructed impeccably which gives the researcher ample motives to pilot the study. A fundamental negative to the study is the minimal justification of choices made throughout the investigation, but the article is empowered by the various limitations which the researchers have identified themselves. Due to the author ascertaining that there could be a need for a supplementary recce, the reader may consider not shifting their existing practice centred around this article alone. Conversely, it would be superbly expedient in further exploration.

Bibliography

• Pope, C., Mays, N. and Popay, J. (2007). Synthesizing qualitative and quantitative health evidence. 1st ed. Maidenhead, England: Open University Press, McGraw Hill Education, p.33.
• Cassens, B.J. (1992). Preventitive medicine and public health. 2nd ed. United States Of America: Lippincott Williams & Wilkins, p.75.
• Tracey, S.J. (2013). Qualitative research methods. Collecting evidence, crafting analysis, communicating impact. 1st ed. West Sussex, England: Wiley-Blackwell
• Birks, M., & Mills, J. (2015). Grounded Theory. 2nd ed. London: Sage publications.
• Boyatzis, R. (2009). Transforming qualitative information. Thousand Oaks (Ca.): Sage Publications, p.7.