Developing a National Trauma Research Action Plan: Results from the trauma systems and informatics panel Delphi
Elliott R Haut1, John P Kirby, Jeffrey A Bailey
1From the Division of Acute Care Surgery, Department of Surgery (E.R.H.), Department of Anesthesiology and Critical Care Medicine (E.R.H.), and Department of Emergency Medicine (E.R.H.), The Johns Hopkins University School of Medicine; The Armstrong Institute for Patient Safety and Quality (E.R.H.), Johns Hopkins Medicine; Department of Health Policy and Management (E.R.H.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Acute and Critical Care Surgery (J.P.K.) and Department of Surgery (J.A.B.), Washington University in St. Louis, St. Louis, Missouri Harborview Injury Prevention and Research Center (J.P.), University of Washington, Seattle, Washington Trauma Surgery and Surgical Critical Care (B.G.), University of Cincinnati Medical Center, Cincinnati, Ohio Department of Surgery (K.N.R.), Uniformed Services University School of Medicine, Bethesda, Maryland Department of General Surgery (K.S.), Stanford University, Stanford, California Division of Traumatology, Surgical Critical Care and Emergency Surgery (J.W.C.), University of Pennsylvania, Philadelphia, Pennsylvania The Coalition for National Trauma Research (M.A.P.), San Antonio, Texas Department of Surgery (E.M.B.), University of Washington, Seattle, Washington Coalition for National Trauma Research (NRAP Trauma Systems and Informatics Panel), San Antonio, Texas.
Background:
The National Academies of Sciences, Engineering, and Medicine 2016 report on the trauma care system recommended establishing a National Trauma Research Action Plan to strengthen and guide future trauma research. To address this recommendation, the Department of Defense funded a study to generate a comprehensive research agenda spanning the trauma and burn care continuum. Panels were created to conduct a gap analysis and identify high-priority research questions. The National Trauma Research Action Plan panel reported here addressed trauma systems and informatics.
Methods:
Experts were recruited to identify current gaps in trauma systems research, generate research questions, and establish the priorities using an iterative Delphi survey approach from November 2019 through August 2020. Panelists were identified to ensure heterogeneity and generalizability, including military and civilian representation. Panelists were encouraged to use a PICO format to generate research questions: patient/population, intervention, compare/control, and outcome. In subsequent surveys, panelists prioritized each research question on a 9-point Likert scale, categorized as low-, medium-, and high-priority items. Consensus was defined as ≥60% agreement.
Results:
Twenty-seven subject matter experts generated 570 research questions, of which 427 (75%) achieved the consensus threshold. Of the consensus reaching questions, 209 (49%) were rated high priority, 213 (50%) medium priority, and 5 (1%) low priority. Gaps in understanding the broad array of interventions were identified, including those related to health care infrastructure, technology products, education/training, resuscitation, and operative intervention. The prehospital phase of care was highlighted as an area needing focused research.
Conclusion:
This Delphi gap analysis of trauma systems and informatics research identified high-priority research questions that will help guide investigators and funding agencies in setting research priorities to continue to work toward Zero Preventable Deaths after trauma.
Level Of Evidence:
Therapeutic/Care Management; Level IV.
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