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Developing a National Trauma Research Action Plan: Results from the Pediatric Research Gap Delphi Survey
Jonathan I Groner1, Jimmy Phuong, Michelle A Price
1From the Department of Pediatric Surgery (J.I.G.), Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; University of Washington (J.P.), Seattle, Washington; Coalition for National Trauma Research (M.A.P., P.J.B.), San Antonio, Texas; Pediatric Surgery (P.F.E.), University of Michigan Injury Center, Ann Arbor, Michigan; Division of Emergency Trauma and Burn Surgery (R.S.B.), Children's National Hospital, Washington, DC; Department of Surgery (A.R.J.), University of California San Francisco/Benioff Children's Hospital Oakland, Oakland, California; Department of Epidemiology (F.P.R.), University of Washington, Seattle, Washington; Department of Pediatric Neurosurgery (E.A.S.), Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; and Trauma Surgery & Surgical Critical Care (E.M.B.), University of Washington, Seattle, Washington.
Background:
In 2016, the National Academies of Sciences, Engineering, and Medicine trauma report recommended a National Trauma Research Action Plan to "strengthen trauma research and ensure that the resources available for this research are commensurate with the importance of injury and the potential for improvement in patient outcomes." With a contract from the Department of Defense, the Coalition for National Trauma Research created 11 expert panels to address this recommendation, with the goal of developing a comprehensive research agenda, spanning the continuum of trauma and burn care. This report outlines the work of the group focused on pediatric trauma.
Methods:
Experts in pediatric trauma clinical care and research were recruited to identify gaps in current clinical pediatric trauma research, generate research questions, and establish the priority of these questions using a consensus-driven Delphi survey approach. Using successive surveys, participants were asked to rank the priority of each research question on a 9-point Likert scale categorized to represent priority. Consensus was defined as >60% agreement within the priority category. Priority questions were coded based on a dictionary of 118 National Trauma Research Action Plan taxonomy concepts in 9 categories to support comparative analysis across all panels.
Results:
Thirty-seven subject matter experts generated 625 questions. A total of 493 questions (79%) reached consensus on priority level. Of those reaching consensus, 159 (32%) were high, 325 (66%) were medium, and 9 (2%) were low priority. The highest priority research questions related to surgical interventions for traumatic brain injury (intracranial pressure monitoring and craniotomy); the second highest priority was hemorrhagic shock. The prehospital setting was the highest priority phase of care.
Conclusion:
This diverse panel of experts determined that most significant pediatric trauma research gaps were in traumatic brain injury, hemorrhagic shock, and the prehospital phase of care. These research domains should be top priorities for funding agencies.
Level Of Evidence:
Therapeutic / Care Management; Level IV.
