Physicians’ Knowledge of the Systematic ABCDE Approach in Riyadh, Saudi Arabia

Figures & data

Table 1 Sociodemographic Characteristics and Experience of Participants

		N	%
Residing in Riyadh	Yes	165	100.0%
Primary Area of Practice	Family Medicine	32	19.4%
	Emergency Medicine	26	15.8%
	Pediatrics	21	12.7%
	Internal Medicine	21	12.7%
	Surgery / Trauma	16	9.7%
	Intensive Care Medicine	13	7.9%
	Anesthesiology	12	7.3%
	Obstetrics and Gynecology	9	5.5%
	Cardiology	7	4.2%
	Graduate Medical Student	6	3.6%
	Intensive Care Medicine, Pediatrics	1	0.6%
	Emergency Medicine, Surgery / Trauma	1	0.6%
Level of Experience	Resident	56	33.9%
	Consultant	41	24.8%
	Intern	33	20.0%
	Senior Registrar	15	9.1%
	Registrar	14	8.5%
	Fellow	6	3.6%
Duration Worked in Profession (since first graduating as a doctor)	Less than 5 years	92	55.8%
	10 to 15 years	26	15.8%
	More than 15 years	25	15.2%
	5 to 10 years	22	13.3%

Table 2 Questions Assessing Knowledge of ABCDE Approach with Their Correct Answers and Percentage of Participants with Correct Response

Questions Assessing Knowledge of ABCDE Approach	Correct Answer	Percentage of Correct Responses
1. What is usually a late sign of circulatory failure?	Hypotension	48.5%
2. Where is the airway obstruction located when you hear expiratory wheezing?	Lower airway	48.5%
3. At which locations can an internal bleeding cause a hypovolemic shock?	Thorax, abdomen, pelvis, upper leg	61.2%
4. Which of the following aspects helps with assessing the effort of breathing, additional to frequency of breathing?	Use of accessory breathing muscles	68.5%
5. What blood value is always part of the primary survey?	Glucose	33.3%
6. A patient has a capillary refill time of 4 seconds on the sternum. This is.	Abnormal	80.0%
7. On which of the following moments in the assessment of the patient do you use the ABCDE approach?	Both of the above	50.9%
8. What does the P in the AVPU-score mean?	Patient responds to pain	61.2%
9. Classify the items below in order of priority according to the ABCDE approach:	3, 2, 1	46.7%
I. AVPU-score
II. Assessing capillary refill time
III. Look-listen-feel
10. What aspect is not part of the D in the ABCDE approach?	Temperature measurement	46.7%
11. What is, at any age, most informative for determining an open airway?	Normal sound of voice (crying, talking)	61.2%
12. Which of the following actions does not contribute to diagnosing a tension pneumothorax?	Observing retractions	58.2%
13. Which C-problem is treated prior to the actual ABCDE approach?	Massive, visual hemorrhage	55.2%
14. What are the 4 most essential parts for assessing a patient’s circulatory condition?	Blood pressure, capillary refill time, heart rate, pulsations	32.7%
15. Which of the following aspects is assessed in the E of the ABCDE approach?	Petechiae	34.5%
16. Which of the following parameters is most reliable when assessing the effectiveness of breathing (in ambient air)?	Oxygen saturation	49.7%
17. What is the most uniform sign of increased effort of breathing, for all ages?	Increased breathing rate	30.3%
18. Upon what is the fixed order of the ABCDE approach mostly based?	This is based upon priority	47.9%
19. Which item is assessed in the E of the ABCDE approach?	Body temperature	49.7%
20. What is not a sign of shock?	Polyuria	70.9%
21. A prolonged capillary refill time could be present in which of the following situations?	2 and 3	64.2%
I. Hypertension
II. Hypothermia
III. Shock
22. Which abnormality in a patient’s posture is most severe?	Stretching arms and legs	31.5%
23. What is the safest maneuver to secure the airway of a trauma patient?	Jaw thrust	37.6%
24. Which aspects of the pupils always have to be assessed for every critically ill patient?	Size and light reactivity	73.9%
25. What is the look-listen-feel method namely meant for?	Assessing the airway	44.2%
26. Which muscle is an accessory breathing muscle?	Sternocleidomastoid muscle	46.1%
27. What does a stridor (inspiratory) indicate?	Upper airway obstruction	58.8%
28. What does jugular venous distension indicate?	2, 3, 4	58.2%
I. Anaphylaxis
II. Heart failure
III. Pericardial tamponade
IV. Pneumothorax
29. With what can you make a quick estimation of a patient’s awareness?	AVPU-score	49.1%

Table 3 Association of Knowledge of ABCDE Approach with Area of Practice, Level of Experience and Duration Worked in Profession

		Knowledge Score
		Median	IQR	P-value ^a
Overall Score		15.0	10.0–20.0	-
Primary Area of Practice^± (N=163)	Intensive Care Medicine	19.0	12.0–21.0	0.011*
	Internal Medicine	17.0	13.0–20.0
	Graduate Medical Student	16.5	15.0–21.0
	Surgery / Trauma	16.0	13.5–19.5
	Family Medicine	15.5	10.0–20.0
	Emergency Medicine	15.5	10.0–23.0
	Pediatrics	14.0	13.0–18.0
	Obstetrics and Gynecology	14.0	11.0–17.0
	Cardiology	8.0	4.0–10.0
	Anesthesiology	7.5	4.0–13.5
Level of Experience	Senior Registrar	20.0	14.0–22.0	<0.001*
	Registrar	19.0	16.0–22.0
	Consultant	17.0	11.0–21.0
	Resident	14.0	10.5–20.0
	Intern	12.0	8.0–16.0
	Fellow	8.5	7.0–13.0
Duration Worked in Profession (since first graduating as a doctor)	10 to 15 years	20.0	16.0–23.0	<0.001*
	More than 15 years	19.0	17.0–22.0
	5 to 10 years	16.5	11.0–20.0
	Less than 5 years	12.0	8.5–16.5

Notes: ^aIndependent Samples Kruskal–Wallis Test. *p<0.05, Significant. ^±Two Participants with Multiple Primary Area of Practices were Excluded.

Figure 1 Association of Knowledge of ABCDE Approach with Primary area of Practice.

Figure 2 Association of Knowledge of ABCDE Approach with Level of Experience.

Figure 3 Association of Knowledge of ABCDE Approach with Duration Worked in The Profession.