Translatability and validation of non-technical skills scale for trauma (T-NOTECHS) for assessing simulated multi-professional trauma team resuscitations

BACKGROUND: The 5-item non-technical skills scale for trauma (T-NOTECHS) with five response categories is developed to assess non-technical skills in trauma team resuscitations. This validated instrument assesses behavioral aspects in teamwork. Outcome instruments should undergo a robust adaptation process followed by psychometric validation to maintain their measurement properties when translated into different languages. The translatability of the T-NOTECHS into a non-Anglo-Saxon language has not been thus far unraveled. The authors aimed to assess whether the T-NOTECHS would be translatable into a non-Anglo-Saxon language and to investigate its psychometric properties for simulated multi-professional trauma team resuscitations. METHODS: The T-NOTECHS (scores: 1 = poor; 5 = excellent) was translated and cross-culturally adapted into Finnish. Data was derived from 61 real hospital trauma team resuscitation simulations with 193 multi-professional participants. Floor-ceiling effects, internal consistency, and inter-rater reliability were analyzed. An exploratory factor analysis was conducted to test construct validity. RESULTS: After pre-testing, minor changes were made to the Finnish translation of the T-NOTECHS. Mean scores of two raters were 3.76 and 4.01, respectively. The T-NOTECHS instrument showed no floor-effect either in single items or in the total score. The total score of the T-NOTECHS instrument showed a percentage of maximum scores of 1.6 and 4.9% by the Raters 1 and 2, respectively. Internal consistency (Cronbach’s alpha) was 0.70 with inter-item correlation of 0.54. The intraclass correlation coefficient was 0.54 and coefficient of repeatability 1.53. The T-NOTECHS loaded on one factor. CONCLUSIONS: The T-NOTECHS translated well into a difficult non-Anglo-Saxon language. The rigorous adaptation process used here can be recommended in the translation of observational performance assessment instruments. The translated version demonstrated fair reliability and good construct validity for assessing team performance in simulated multi-professional trauma team resuscitations. The translated T-NOTECHS instrument can be used to assess the efficacy of simulated in-situ trauma team resuscitations allowing benchmarking and international collaboration.