TRAUMA QUALITY IMPROVEMENT
Comparative analysis of the STAT taxonomy and T-NOTECHS for trauma team non-technical skills
Published on
Sep 1, 2025
Injury
Anisa Nazir, Eliane M Shore, Ryan P Dumas, Caitlin Fitzgerald, Melissa McGowan, Charles Keown-Stoneman, Teodor Grantcharov, Brodie Nolan; FIRST60 Investigators
Overview
Non-technical skills (NTS), including leadership, communication, situational awareness, cooperation and resource management, and decision-making, are essential for effective teamwork during trauma resuscitations and may influence the occurrence of adverse events (AEs). This secondary analysis examined the relationship between NTS and AEs using two validated frameworks: the Trauma NOn-TECHnical Skills (T-NOTECHS) tool and the Safety Threats and Adverse Events in Trauma (STAT) taxonomy. T-NOTECHS evaluates team-based behaviors across five domains, while the STAT taxonomy categorizes safety threats and AEs identified during trauma care. By integrating these tools, the study aimed to determine whether higher non-technical performance is associated with fewer AEs in trauma resuscitations.
The analysis included 30 adult trauma team activations recorded through trauma video review at Parkland Hospital between January 2019 and January 2022. T-NOTECHS scores were assigned by a trained reviewer based on five behavioral domains using a five-point Likert scale, while AEs were identified and categorized using the STAT taxonomy in a previously conducted study of the same cases. Descriptive statistics summarized team performance, patient characteristics, and AE frequency. Poisson regression models were used to examine the association between T-NOTECHS scores and AE counts, with additional analyses adjusting for patient age, sex, and Injury Severity Score (ISS). Sensitivity analyses were conducted using modified versions of both tools to assess the robustness of the relationship while minimizing conceptual overlap.
Results
Across the 30 trauma resuscitations, T-NOTECHS scores ranged from 17 to 25 with a median of 22, indicating generally high levels of non-technical team performance. A total of 298 adverse events were identified, with the number of AEs per case ranging from 4 to 29 and a median of 9.5. Among the five T-NOTECHS domains, leadership, crisis resource management, assessment and decision-making, and situational awareness had the highest median scores, while communication and interaction had slightly lower scores. The most frequent AEs included failure to obtain temperature measurements, insufficient use of personal protective equipment, and lack of closed-loop communication.
Poisson regression demonstrated a significant inverse association between T-NOTECHS scores and AE frequency. In the adjusted multivariable model, each one-point increase in the T-NOTECHS score was associated with an 11 percent reduction in the expected rate of AEs (IRR = 0.89, 95 percent CI 0.84 to 0.94, p < 0.001). Age was associated with a small increase in AE rates, whereas sex and Injury Severity Score were not significant predictors. Sensitivity analyses excluding overlapping constructs between the two frameworks showed a persistent negative correlation between modified T-NOTECHS and STAT scores (Spearman’s rho = −0.451, p = 0.01), supporting the robustness of the observed relationship between trauma team non-technical performance and adverse event frequency.
Peer-reviewed Research
