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Developing a National Trauma Research Action Plan: Results from the acute resuscitation, initial patient evaluation,
Todd W Costantini1, Joseph M Galante, Maxwell A Braverman
1From the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego School of Medicine (T.W.C.), San Diego, CA; Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of California Davis School of Medicine (J.M.G.), Sacramento, CA; Coalition for National Trauma Research, (M.A.B.), San Antonio, TX; Harborview Injury Prevention and Research Center, University of Washington (J.P.), Seattle, WA; Coalition for National Trauma Research, (M.A.P.), San Antonio, TX; Division of General Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco School of Medicine (J.C.), San Francisco, CA; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego School of Medicine (L.N.G.); San Diego, CA; Division of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine (J.B.H.); Birmingham, AL; Riverside University Health System Medical Center, Loma Linda University School of Medicine (R.C.); Riverside, CA; and Division of Trauma, Burn and Critical Care Surgery, Department of Surgery, University of Washington School of Medicine (E.M.B.); Seattle, WA.
Background:
Injury is the leading cause of death in patients aged 1 to 45 years and contributes to a significant public health burden for individuals of all ages. To achieve zero preventable deaths and disability after injury, the National Academies of Science, Engineering and Medicine called for the development of a National Trauma Research Action Plan to improve outcomes for military and civilian trauma patients. Because rapid resuscitation and prompt identification and treatment of injuries are critical in achieving optimal outcomes, a panel of experts was convened to generate high-priority research questions in the areas of acute resuscitation, initial evaluation, imaging, and definitive management on injury.
Methods:
Forty-three subject matter experts in trauma care and injury research were recruited to perform a gap analysis of current literature and prioritize unanswered research questions using a consensus-driven Delphi survey approach. Four Delphi rounds were conducted to generate research questions and prioritize them using a 9-point Likert scale. Research questions were stratified as low, medium, or high priority, with consensus defined as ≥60% of panelists agreeing on the priority category. Research questions were coded using a taxonomy of 118 research concepts that were standard across all National Trauma Research Action Plan panels.
Results:
There were 1,422 questions generated, of which 992 (69.8%) reached consensus. Of the questions reaching consensus, 327 (33.0%) were given high priority, 621 (62.6%) medium priority, and 44 (4.4%) low priority. Pharmaceutical intervention and fluid/blood product resuscitation were most frequently scored as high-priority intervention concepts. Research questions related to traumatic brain injury, vascular injury, pelvic fracture, and venous thromboembolism prophylaxis were highly prioritized.
Conclusion:
This research gap analysis identified more than 300 high-priority research questions within the broad category of Acute Resuscitation, Initial Evaluation, Imaging, and Definitive Management. Research funding should be prioritized to address these high-priority topics in the future.
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