Table 5.
Mean (95% CI) of salivary cortisol (nmol/L), STAI and CA during simulation in management of an emergency caesarean section and postpartum haemorrhage conducted as ISS and OSS
| Baseline | Postsimulation 0 min Mean* |
Postsimulation 5 min Mean* |
Postsimulation 10 min Mean* |
Peak-level mean*† | Mean difference*‡ of baseline to peak of ΔOSS versus ΔISS | ||
|---|---|---|---|---|---|---|---|
| First simulation: emergency caesarean section | |||||||
| Cortisol | ISS | 7.0 (6.3 to 7.8) | 8.9 (7.2 to 10.6) | 8.1 (6.6 to 9.6) | 8.1 (6.6 to 9.5) | 9.3 (7.6 to 11.0) | −0.5 (−1.6 to 2.5) p=0.64 |
| OSS | 7.3 (5.3 to 9.2) | 8.2 (6.3 to 10.2) | 7.8 (6.1 to 9.6) | 8.0 (6.2 to 9.8) | 9.0 (6.9 to 11.1) | ||
| STAI | ISS | 32.2 (30.4 to 34.0) | 34.8 (32.7 to 37.0) | 31.3 (29.5 to 33.1) | 36.5 (34.3 to 38.7) | −0.2 (−2.1 to 2.5) p=0.85 | |
| OSS | 33.1 (31.1 to 35.0) | 34.8 (32.2 to 37.3) | 30.7 (29.0 to 32.4) | 37.0 (34.7 to 39.3) | |||
| CA | ISS | 1.0 (0.9 to 1.1) | 0.8 (0.7 to 1.0) | 0.8 (0.7 to 0.9) | 0.8 (0.7 to 1.0.) | 0.0 (−0.2 to 0.2) p=0.93 | |
| OSS | 1.0 (1.0 to 1.1) | 0.8 (0.7 to 0.9) | 0.8 (0.6 to 0.9) | 0.9 (0.7 to 0.9) | |||
| Second simulation: postpartum haemorrhage | |||||||
| Cortisol | ISS | 7.4 (6.5 to 8.3) | 9.2 (7.7 to 10.7) | 7.7 (6.6 to 8.8) | 7.4 (6.3 to 8.5) | 9.4 (7.9 to 10.9) | −1.2 (−0.1 to 0.25) p=0.07 |
| OSS | 6.9 (5.9 to 7.9) | 7.5 (6.6 to 8.4) | 6.7 (5.8 to 7.7) | 6.8 (6.0 to 7.6) | 7.7 (6.7 to 8.7) | ||
| STAI | ISS | 31.8 (30.0 to 33.6) | 31.8 (30.1 to 33.6) | 28.5 (27.3 to 29.7) | 32.2 (30.5 to 33.9) | −0.5 (−2.2 to 1.3) p=0.61 | |
| OSS | 32.1 (29.9 to 34.2) | 32.4 (30.5 to 34.3) | 30.1 (28.5 to 31.8) | 32.8 (31.0 to 34.7) | |||
| CA | ISS | 1.0 (0.9 to 1.1) | 0.8 (0.7 to 0.9) | 0.8 (0.7 to 0.9) | 0.8 (0.7 to 0.9) | 0.1 (−0.2 to 0.1) p=0.56 | |
| OSS | 1.1 (1.0 to 1.2) | 0.9 (0.7 to 1.0) | 0.8 (0.7 to 0.9) | 0.9 (0.7 to 1.0) | |||
*Based on generalised estimating equations to account for potential correlation within teams.
†Peak level is the maximum of the measurements obtained at 0, 5 and 10 min after the end of the simulation.
‡Adjusted for pre-cortisol, pre-STAI and pre-CA (ANCOVA).
ANCOVA, analysis of covariance;CA, cognitive appraisal (range 0.1–10); ISS, in situ simulation; OSS, off-site simulation; STAI, Stress-Trait Anxiety Inventory (range 20–80).