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Physician experiences with clinical uncertainty in the trauma setting: making clinical guidance accessible to those in need
Author(s)
The University of Texas Southwestern Medical Center
E J Lee
University of Colorado Anschutz
Gianni Aragon
Hospital de Emergencias Jose Casimiro Ulloa
Giuliano Borda‐Luque
Universidad Peruana Cayetano Heredia
Gabriela Zavala Wong
Universidad Peruana Cayetano Heredia
Ana Lucia Carranza
Universidad Peruana Cayetano Heredia
Eduardo Huaman
Hospital Base Guillermo Almenara Irigoyen
Andrea Olabarrera
Universidad Científica del Sur
Manuel J Rodríguez
Universidad Peruana Cayetano Heredia
Kirsten Senturia
University of Washington
Lucas Távara Wiess
Universidad Peruana Cayetano Heredia
Lacey N. LaGrone
University of Colorado Health
Date Issued
1 de enero de 2026
Type
Article
Volume
11
Issue
1
Series/Report No.
Trauma Surgery & Acute Care Open
Start Page
e001924
End Page
e001924
ISSN
2397-5776
Abstract
Introduction: Globally, trauma patients suffer from high rates of preventable deaths, in part driven by low rates of access to and application of resource-relevant evidence-informed clinical guidance. This mixed-methods study assessed the accessibility (barriers to attempting to use guidance), clarity (ease of comprehension), utility (based on resources and time), and implementation of trauma guidance for Peruvian injury providers. Methods: Semistructured qualitative interviews were conducted in Spanish at three hospitals in Lima, Peru. Interviews were analyzed in Dedoose V.9.1.12 using an iteratively developed codebook; quantitative self-administered surveys were then developed and distributed at the Pan American Trauma Society Conference. Surveys were analyzed using descriptive statistics and frequencies. Results: 38 interviews and 83 surveys were conducted with surgical attendings, emergency physicians, and surgical and emergency residents across all years of training. Access barriers included paywalls, language barriers, low user-friendliness, and technology limits (poor internet, few computers). A mobile app and portable physical guidance are preferred potential solutions. Utility barriers included low equipment maintenance and high patient volumes. Resource-based guidance, conciseness (eg, flowcharts), and standardization are perceived to potentially increase utility. Implementation barriers included limited training time, reliance on more experienced colleagues rather than guidance, low enforcement, and low funding. Potential facilitators are increased administrative support and staff willingness to use guidance improving patient mortality, clinical errors, and length of stay. No barriers to clarity were reported. Conclusion: Barriers to using clinical guidance included low user-friendliness, low local applicability, and an unsupportive culture. Mobile apps, resource stratification, and administrative involvement are priorities to address these needs. Trauma guidance adapted to local realities may reduce preventable deaths in acute care. Further work is needed to identify how to create and distribute updated clinical guidance to better serve trauma providers worldwide. Level of evidence: Economic and Value-based Evaluations Level 2.
Keywords