From the Research Sub-Committee, Committee on Surgical Combat Casualty Care, Joint Trauma System, San Antonio, Texas.
J Trauma Acute Care Surg. 2019 Jul;87(1S Suppl 1):S14-S21. doi: 10.1097/TA.0000000000002200.
The US Military has achieved the highest casualty survival rates in its history. However, there remain multiple areas in combat trauma that present challenges to the delivery of high-quality and effective trauma care. Previous work has identified research priorities for pre-hospital care, but there has been no similar analysis for forward surgical care.
A list of critical "focus areas" was developed by the Committee on Surgical Combat Casualty Care (CoSCCC). Individual topics were solicited and mapped to appropriate focus areas by group consensus and review of Eastern Association for the Surgery of Trauma (EAST) and Joint Trauma System guidelines. A web-based survey was distributed to the CoSCCC and the military committees of EAST and the American Association for the Surgery of Trauma. Topics were rated on a Likert scale from 1 (low) to 10 (high priority). Descriptives, univariate statistics, and inter-rater correlation analysis was performed.
13 research focus areas were identified (eight clinical and five adjunctive categories). Ninety individual topics were solicited. The survey received 64 responses. The majority of respondents were military (90%) versus civilians (10%). There was moderate to high agreement (inter-rater correlation coefficient = 0.93, p < 0.01) for 10 focus areas. The top five focus areas were Personnel/Staffing (mean, 8.03), Resuscitation and Hemorrhage Management (7.49), Pain/Sedation/Anxiety Management (6.96), Operative Interventions (6.9), and Initial Evaluation (6.9). The "Top 10" research priorities included four in Personnel/Staffing, four in Resuscitation/Hemorrhage Management, and three in Operative Interventions. A complete list of the topics/scores will be presented.
This is the first objective ranking of research priorities for combat trauma care. The "Top 10" priorities were all from three focus areas, supporting prioritization of personnel/staffing of austere teams, resuscitation/hemorrhage control, and damage-control interventions. This data will help guide Department of Defense research programs and new areas for prioritized funding of both military and civilian researchers.
Study design, level IV.
美国军方在历史上实现了最高的伤员存活率。然而，在提供高质量和有效的创伤护理方面，仍有多个战场创伤领域存在挑战。之前的工作已经确定了前院护理的研究重点，但对于前线外科护理还没有类似的分析。
外科战斗伤员护理委员会（CoSCCC）制定了一份关键“重点领域”清单。通过小组共识和对东部创伤外科学会（EAST）和联合创伤系统指南的审查，征集各个专题并将其映射到适当的重点领域。向 CoSCCC 以及 EAST 和美国创伤外科学会的军事委员会分发了一份基于网络的调查。主题按照从 1（低）到 10（高优先级）的李克特量表进行评分。进行描述性统计、单变量统计和评分者间相关性分析。
确定了 13 个研究重点领域（8 个临床和 5 个辅助类别）。共征集了 90 个专题。该调查共收到 64 份回复。大多数回复者是军人（90%），而非平民（10%）。对于 10 个重点领域，存在中度至高度一致（评分者间相关性系数=0.93，p<0.01）。排名前五的重点领域是人员/人员配备（平均值，8.03）、复苏和出血管理（7.49）、疼痛/镇静/焦虑管理（6.96）、手术干预（6.9）和初始评估（6.9）。“十大”研究重点包括人员/人员配备领域的四项，复苏/出血管理领域的四项，手术干预领域的三项。将展示完整的主题/分数清单。
这是首个针对战场创伤护理的研究重点客观排名。“十大”重点都来自三个重点领域，这支持了对艰苦团队人员/人员配备、复苏/出血控制以及损伤控制干预的优先级排序。这一数据将有助于指导国防部研究计划，并为军方和民用研究人员优先资助新领域。
研究设计，四级。
