Department of Emergency Medicine, University of North Carolina, 170 Manning Dr, Chapel Hill, NC 27599, USA.
Ann Emerg Med. 2010 Nov;56(5):538-50. doi: 10.1016/j.annemergmed.2010.05.029.
The National Institutes of Health (NIH) formed an NIH Task Force on Research in Emergency Medicine to enhance NIH support for emergency care research. The NIH Trauma Research Roundtable was convened on June 22 to 23, 2009. The objectives of the roundtable are to identify key research questions essential to advancing the scientific underpinnings of emergency trauma care and to discuss the barriers and best means to advance research by exploring the role of trauma research networks and collaboration between NIH and the emergency trauma care community.
Before the roundtable, the emergency care domains to be discussed were selected and experts in each of the fields were invited to participate in the roundtable. Domain experts were asked to identify research priorities and challenges and separate them into mechanistic, translational, and clinical categories. During and after the conference, the lists were circulated among the participants and revised to reach a consensus.
Emergency trauma care research is characterized by focus on the timing, sequence, and time sensitivity of disease processes and treatment effects. Rapidly identifying the phenotype of patients on the time spectrum of acuity and severity after injury and the mechanistic reasons for heterogeneity in outcome are important challenges in emergency trauma research. Other research priorities include the need to elucidate the timing, sequence, and duration of causal molecular and cellular events involved in time-critical injuries, and the development of treatments capable of halting or reversing them; the need for novel experimental models of acute injury; the need to assess the effect of development and aging on the postinjury response; and the need to understand why there are regional differences in outcomes after injury. Important barriers to emergency care research include a limited number of trained investigators and experienced mentors, limited research infrastructure and support, and regulatory hurdles.
The science of emergency trauma care may be advanced by facilitating the following: (1) development of an acute injury template for clinical research; (2) developing emergency trauma clinical research networks; (3) integrating emergency trauma research into Clinical and Translational Science Awards; (4) developing emergency care-specific initiatives within the existing structure of NIH institutes and centers; (5) involving acute trauma and emergency specialists in grant review and research advisory processes; (6) supporting learn-phase or small, clinical trials; (7) performing research to address ethical and regulatory issues; and (8) training emergency care investigators with research training programs.
美国国立卫生研究院（NIH）成立了 NIH 急诊医学研究工作组，以加强 NIH 对急诊护理研究的支持。NIH 创伤研究圆桌会议于 2009 年 6 月 22 日至 23 日召开。本次会议的目的是确定关键研究问题，这些问题对于推进急诊创伤护理的科学基础至关重要，并通过探讨创伤研究网络和 NIH 与急诊创伤护理界之间的合作在推进研究方面的作用，讨论障碍和最佳手段。
在圆桌会议之前，选择了要讨论的紧急护理领域，并邀请了每个领域的专家参加圆桌会议。要求领域专家确定研究重点和挑战，并将其分为机制、转化和临床类别。在会议期间和之后，将清单在参与者之间传阅并进行修订以达成共识。
急诊创伤护理研究的特点是关注疾病过程和治疗效果的时间、顺序和时间敏感性。快速识别受伤时间谱和严重程度上患者的表型以及结果异质性的机制原因是急诊创伤研究中的重要挑战。其他研究重点包括阐明与时间关键伤有关的因果分子和细胞事件的时间、顺序和持续时间，以及开发能够阻止或逆转这些事件的治疗方法的必要性；需要新型急性损伤实验模型；需要评估发育和衰老对受伤后反应的影响；以及需要了解受伤后为什么会出现区域差异。急诊护理研究的重要障碍包括训练有素的研究人员和经验丰富的导师人数有限、研究基础设施和支持有限以及监管障碍。
通过以下措施可以促进急诊创伤护理的科学发展：（1）为临床研究制定急性损伤模板；（2）发展急诊创伤临床研究网络；（3）将急诊创伤研究纳入临床和转化科学奖；（4）在 NIH 研究所和中心的现有结构内制定特定于急诊护理的计划；（5）让急性创伤和急诊专家参与拨款审查和研究咨询过程；（6）支持学习阶段或小型临床试验；（7）进行研究以解决伦理和监管问题；（8）通过研究培训计划培训急诊护理研究人员。
