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Developing a National Trauma Research Action Plan: Results from the prehospital and mass casualty research Delphi
Craig D Newgard1, Maxwell A Braverman, Jimmy Phuong
1From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (C.D.N., M.R.D.), Oregon Health and Science University, Portland, Oregon; Coalition for National Trauma Research (M.A.B., E.S.S., M.A.P., P.J.B.), San Antonio, Texas; Department of Biomedical Informatics and Medical Education (J.P.), University of Washington, Seattle, Washington; Department of Emergency Medicine (E.G.), Brigham and Women's Hospital Harvard Medical School Boston, Massachusetts; Department of Emergency Medicine (E.B.L.), Jacobs School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, New York; Department of Emergency Medicine (F.X.G.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery (S.R.), University of Chicago Medicine and Biological Sciences, Chicago, Illinois; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery (J.D.), University of California San Diego Health, San Diego, California; Department of Surgery (P.J.), Indiana University School of Medicine, Indianapolis, Indiana; Department of Pediatrics (N.C.M.), University of Utah School of Medicine, Salt Lake City, Utah; Department of Surgery (K.S.), Stanford University, Palo Alto, California; Department of Surgery (D.P.B.), Inova Medical Group/Inova Fairfax Medical Campus, Falls Church, Virginia; and Department of Surgery (E.B.), Harborview Medical Center University of Washington, Seattle, Washington.
Background:
The National Academies of Sciences, Engineering, and Medicine 2016 trauma system report recommended a National Trauma Research Action Plan to strengthen and guide future trauma research. To address this recommendation, 11 expert panels completed a Delphi survey process to create a comprehensive research agenda, spanning the continuum of trauma care. We describe the gap analysis and high-priority research questions generated from the National Trauma Research Action Plan panel on prehospital and mass casualty trauma care.
Methods:
We recruited interdisciplinary national experts to identify gaps in the prehospital and mass casualty trauma evidence base and generate prioritized research questions using a consensus-driven Delphi survey approach. We included military and civilian representatives. Panelists were encouraged to use the Patient/Population, Intervention, Compare/Control, and Outcome format to generate research questions. We conducted four Delphi rounds in which participants generated key research questions and then prioritized the questions on a 9-point Likert scale to low-, medium-, and high-priority items. We defined consensus as ≥60% agreement on the priority category and coded research questions using a taxonomy of 118 research concepts in 9 categories.
Results:
Thirty-one interdisciplinary subject matter experts generated 490 research questions, of which 433 (88%) reached consensus on priority. The rankings of the 433 questions were as follows: 81 (19%) high priority, 339 (78%) medium priority, and 13 (3%) low priority. Among the 81 high-priority questions, there were 46 taxonomy concepts, including health systems of care (36 questions), interventional clinical trials and comparative effectiveness (32 questions), mortality as an outcome (30 questions), prehospital time/transport mode/level of responder (24 questions), system benchmarks (17 questions), and fluid/blood product resuscitation (17 questions).
Conclusion:
This Delphi gap analysis of prehospital and mass casualty care identified 81 high-priority research questions to guide investigators and funding agencies for future trauma research.
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