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Nursing Evidence-Based Practice Question Development Tool

1. What is the problem? Chest trauma is the third common trauma after head and extremity (Abd Ella, Salem & Zytoon, 2021). Subsequent thoracic injuries associated with 40% mortality rate. One of the most life threatening injuries are pneumothorax and hemothorax. Early diagnosis and interventions to these injuries are lifesaving and prevent subsequent complications (Ebrahimi et al., 2014). Signs and

symptoms of these injuries are almost similar to other respiratory conditions therefore an accurate diagnostic technique is needed. 2. Why is the problem important and relevant? What would happen if it were not addressed? Early and correct diagnosis is needed in chest trauma for rapid treatment initiation, because it’s usually related to a major emergency condition. Early intervention will decrease length of stay in ER, decrease mortality, improve patient outcome and minimize complications. Otherwise, inappropriate and unnecessary treatment will be delivered in the golden time needed for saving patients’ life ( Chan et al., 2020).

Lung ultrasound POCUS (point of care ultrasound) devise has been used in triaging and diagnosing pneumothorax and hemothorax in ER. The devise shown to have 94% sensitivity, it helped in early diagnose better than CXR. A meta-analysis supported its usefulness and accuracy in diagnosing pneumothorax and hemothorax in chest trauma patients in ER. The device is easy to use, available in ER, patient can be easily

and continuously monitored for improvement and deterioration, also there’s’ no radiation exposure risk (Stauba, Biscarob, Kaszubowskie & Mauricic, 2018). 3. What is the current practice? Usually in ER chest x-ray is done to diagnose these conditions, but it has been proved to be insensitive and inaccurate method to diagnose and differentiate lung problems. Sensitivity of chest x-ray is 43.5% and the positive predictive value is 26.9%. For this low values chest CT scan considered a standard way to diagnose respiratory conditions with sensitivity from 97% to 100%, but it cannot be always used in the ER because of patient’s unstable conditions which cannot tolerate transport and imaging position and time, CT device is not available in all emergency departments and the risk of patient’s exposure to high radiation doses. Therefore, CXR is used with physical exam until patient condition is stable and can be transferred to the CT device to confirm the diagnosis and discover the hidden problems (Zieleskiewicz et al., 2021). 4. How was the problem identified? (Check all that apply.) ❑ Safety and risk-management concerns

❑ Variations in practice compared to community standard

Nursing Evidence-Based Practice Question Development Tool ❑ Quality concerns (efficiency, effectiveness, timeliness, equity, patient-centeredness) ❑ Unsatisfactory patient, staff, or organizational outcomes ❑ Variations in practice within the setting

❑ Current practice that has not been validated ❑ Financial concerns

5. What are the PICO components? P –Chest trauma (detect pneumothorax & hemothorax) I – Pocus C – Chest x-ray O – Rapid detection to provide early intervention and prevent further complications. 6. Initial EBP question

❑ Background ❑ Foreground

In adult patients with chest trauma, does pocus devise diagnose pneumothorax and hemothorax more accurately than chest x-ray.

Nursing Evidence-Based Practice Question Development Tool 7. List possible search terms, databases to search, and search strategies.

8. What evidence must be gathered? (Check all that apply.) ❑ Publications (e.g., EBSCOHost, PubMed, CINAHL, Embase) ❑ Standards (regulatory, professional, community) ❑ Guidelines

❑ Organizational data (e.g., QI, financial data, local clinical expertise, patient/family preferences) ❑ Position statements

9. Revised EBP question (Revisions in the EBP question may not be evident until after the initial evidence review; the revision can be in the background question or a change from the background to a foreground question.)

10. Outcome measurement plan What will we How will we How often will Where will measure? measure it? we measure we obtain the (structure, (metrics are it? data? process, expressed as (frequency) outcome rate or percent) measure)

Who will collect the data?

To whom will we report the data?

Nursing Evidence-Based Practice Question Development Tool

References: Abd Ella, T., Salem, S., & Zytoon, A. (2021). The Potential Benefit of Emergency Ultrasound Plus MDCT for The Diagnosis of Major Chest Trauma … A Diagnostic Test Accuracy Study. The Egyptian Journal of Hospital Medicine, 83, 1270-1278. Chan, K., Joo , D., McRae , A., Takwoingi , Y., Premji , Z., Lang , E., & Wakai, A. (2020). Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department. Cochrane Database Syst Rev, 23(7),CD013031. Ebrahimi, A., Yousefifard, M., Kazemi, H., Rasouli, H., Asady, H., Jafari, A., & Hosseini, M. (2014). Diagnostic Accuracy of Chest Ultrasonography versus Chest Radiography for Identification of Pneumothorax: A Systematic Review and MetaAnalysis. Tanaffos, 13(4), 29–40. Stauba,L., Biscarob, R., Kaszubowskie, E., & Mauricic,R. (2018). Chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax: A systematic review and meta-analysis. Injury, 49, 457-466. Zieleskiewicz, L., Lopez, A., Hraiech, S., Baumstarck, K., Pastene, B., Bisceglie, M. … Leone, M. (2021). Bedside POCUS during ward emergencies is associated with improved diagnosis and outcome: an observational, prospective, controlled study. Critical Care, 25, 34....