Analysis on the training effect of criteria and practical guidance for determination of brain death: transcranial Doppler

Abstract

Objective To analyze the training effects of transcranial Doppler (TCD) for brain death determination conducted by Brain Injury Evaluation Quality Control Centre of National Health and Family Planning Commission to optimize the training program and improve the training effects. Methods A total of 106 trainees received theoretical training, simulation skill training, bedside skill training and test analysis on TCD confirmatory test for brain death determination. The composition of trainees was analyzed and the error rates of 6 knowledge points were calculated. Univariate and multivariate backward Logistic regression analyses were used to analyze the influence of factors including sex, age, specialty, professional category professional qualification and hospital level on the error rates. Results The trainees including 42 males and 64 females, came from 69 hospitals. Trainees of 30-49 years old occupied 77.36% (82/106). In the trainees, 96.23% (102/106) were from third grade, grade A hospitals, and most of them were from Department of Neurology (64.15% , 68/106) and Ultrasound (19.81% , 21/106). There were 82 clinicians (77.36%). Thirty four (32.08%) trainees had senior certificate and 49 (46.23%) had intermediate certificate. Total error rate of 6 knowledge points was 7.26% (149/2052). Of the 6 knowledge points, the error rate of parameter setting was the highest (9.43%, 10/106), followed by checking position (8.73%, 37/424), artery recognition (8.67%, 43/496), result determination (7.41%, 55/742), equipment (1.89%, 2/106) and pitfalls (1.12%, 2/178). Univariate and multivariate Logistic regression analyses showed that specialty (OR = 1.313, 95% CI: 1.072-1.610; P = 0.009) and hospital level (OR = 2.943, 95% CI: 1.623-5.338; P = 0.000) were independent risk factors associated with high error rates. Conclusions Among the trainees, degree of mastering the knowledge points is different, and the characteristics of trainees influence the training effect. The training program should be optimized according to key and difficult points to make more and more trainees qualifying for TCD confirmatory test in brain death determination.

DOI: 10.3969/j.issn.1672-6731.2015.12.009