What is the Tanner scale in clinical judgment for trauma assessment?

From the Guidelines

In patients with severe limb trauma, the application of a tourniquet is recommended in the pre-hospital setting when there is active limb hemorrhage and inefficiency of direct compression, amputation, foreign body within the hemorrhagic wound, lack of radial pulse, or multiple simultaneous actions to be carried out, as suggested by experts 1.

Clinical Judgment in Trauma

Tanner's clinical judgment model is highly applicable in trauma care, emphasizing the progression from novice to expert through five stages: novice, advanced beginner, competent, proficient, and expert. In trauma settings, this model helps clinicians develop critical thinking skills essential for rapid assessment and intervention.

• Novice trauma clinicians rely heavily on protocols and checklists like the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure)
• Experts develop intuitive recognition of patterns and can anticipate complications before they manifest This progression is particularly valuable in trauma where quick decisions are necessary with incomplete information.

Application of Tanner's Model

The model encourages trauma teams to develop situational awareness, prioritization skills, and the ability to recognize deviations from expected recovery patterns.

• Implementation of Tanner's model in trauma care involves mentorship programs, simulation training, and debriefing sessions that allow clinicians to reflect on their decision-making processes
• This reflection component is crucial as it helps trauma clinicians learn from both successful and unsuccessful interventions, ultimately improving patient outcomes through enhanced clinical reasoning

Tourniquet Application

In the context of severe limb trauma, the therapeutic approach should prioritize stopping active bleeding to limit blood loss and prevent the vicious circle of the lethal triad and death.

• The application of a tourniquet is probably recommended when direct compression is ineffective, and there are signs of severe hemorrhage or amputation
• Experts suggest re-evaluating the effectiveness, usefulness, and location of the tourniquet as soon as possible to limit morbidity, including the shortest possible application time and the smallest possible area of ischemia 1

From the Research

Tanner Clinical Judgment in Trauma

• The concept of Tanner clinical judgment in trauma is not directly addressed in the provided studies 2, 3, 4.
• However, the studies discuss the evolution and development of the Advanced Trauma Life Support (ATLS) protocol, which is a standardized approach to assessing and managing trauma patients 2.
• The ATLS protocol emphasizes the importance of clinical judgment in trauma care, including the use of indices to predict outcome, morbidity, and mortality 2.
• A study published in 2014 introduced a simple shock grading tool based on the ATLS classification, which incorporates vital signs, fluid response, and estimated blood loss to describe shock grade during the primary survey 3.
• The study found that the shock grading tool had a high sensitivity and diagnostic accuracy in detecting significant hemorrhage in trauma patients 3.
• Another study published in 2019 discussed updates to the ATLS protocol, including a more structured approach to trauma patients and advances in trauma resuscitation, such as less stringent guidelines for crystalloid administration and the use of viscoelastic methods to guide transfusion decisions 4.
• While these studies do not specifically address Tanner clinical judgment, they highlight the importance of clinical judgment and standardized approaches in trauma care 2, 3, 4.