制定国家创伤研究行动计划：院前和大规模伤亡研究德尔菲调查结果
Developing a National Trauma Research Action Plan: Results from the prehospital and mass casualty research Delphi survey.
作者信息
Newgard Craig D, Braverman Maxwell A, Phuong Jimmy, Shipper Edward S, Price Michelle A, Bixby Pamela J, Goralnick Eric, Daya Mohamud R, Lerner E Brooke, Guyette Francis X, Rowell Susan, Doucet Jay, Jenkins Peter, Mann N Clay, Staudenmayer Kristan, Blake David P, Bulger Eileen
机构信息
From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (C.D.N., M.R.D.), Oregon Health and Science University, Portland, Oregon; Coalition for National Trauma Research (M.A.B., E.S.S., M.A.P., P.J.B.), San Antonio, Texas; Department of Biomedical Informatics and Medical Education (J.P.), University of Washington, Seattle, Washington; Department of Emergency Medicine (E.G.), Brigham and Women's Hospital Harvard Medical School Boston, Massachusetts; Department of Emergency Medicine (E.B.L.), Jacobs School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, New York; Department of Emergency Medicine (F.X.G.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery (S.R.), University of Chicago Medicine and Biological Sciences, Chicago, Illinois; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery (J.D.), University of California San Diego Health, San Diego, California; Department of Surgery (P.J.), Indiana University School of Medicine, Indianapolis, Indiana; Department of Pediatrics (N.C.M.), University of Utah School of Medicine, Salt Lake City, Utah; Department of Surgery (K.S.), Stanford University, Palo Alto, California; Department of Surgery (D.P.B.), Inova Medical Group/Inova Fairfax Medical Campus, Falls Church, Virginia; and Department of Surgery (E.B.), Harborview Medical Center University of Washington, Seattle, Washington.
出版信息
J Trauma Acute Care Surg. 2022 Feb 1;92(2):398-406. doi: 10.1097/TA.0000000000003469.
BACKGROUND
The National Academies of Sciences, Engineering, and Medicine 2016 trauma system report recommended a National Trauma Research Action Plan to strengthen and guide future trauma research. To address this recommendation, 11 expert panels completed a Delphi survey process to create a comprehensive research agenda, spanning the continuum of trauma care. We describe the gap analysis and high-priority research questions generated from the National Trauma Research Action Plan panel on prehospital and mass casualty trauma care.
METHODS
We recruited interdisciplinary national experts to identify gaps in the prehospital and mass casualty trauma evidence base and generate prioritized research questions using a consensus-driven Delphi survey approach. We included military and civilian representatives. Panelists were encouraged to use the Patient/Population, Intervention, Compare/Control, and Outcome format to generate research questions. We conducted four Delphi rounds in which participants generated key research questions and then prioritized the questions on a 9-point Likert scale to low-, medium-, and high-priority items. We defined consensus as ≥60% agreement on the priority category and coded research questions using a taxonomy of 118 research concepts in 9 categories.
RESULTS
Thirty-one interdisciplinary subject matter experts generated 490 research questions, of which 433 (88%) reached consensus on priority. The rankings of the 433 questions were as follows: 81 (19%) high priority, 339 (78%) medium priority, and 13 (3%) low priority. Among the 81 high-priority questions, there were 46 taxonomy concepts, including health systems of care (36 questions), interventional clinical trials and comparative effectiveness (32 questions), mortality as an outcome (30 questions), prehospital time/transport mode/level of responder (24 questions), system benchmarks (17 questions), and fluid/blood product resuscitation (17 questions).
CONCLUSION
This Delphi gap analysis of prehospital and mass casualty care identified 81 high-priority research questions to guide investigators and funding agencies for future trauma research.
背景
美国国家科学院、工程院和医学院2016年的创伤系统报告建议制定一项国家创伤研究行动计划，以加强和指导未来的创伤研究。为落实这一建议，11个专家小组完成了一项德尔菲调查过程，以制定一个涵盖创伤护理全过程的综合研究议程。我们描述了从国家创伤研究行动计划中关于院前和大规模伤亡创伤护理的专家小组所产生的差距分析和高优先级研究问题。
方法
我们招募了跨学科的国内专家，以确定院前和大规模伤亡创伤证据基础中的差距，并使用基于共识的德尔菲调查方法提出优先研究问题。我们纳入了军事和民事代表。鼓励小组成员使用患者/人群、干预措施、对照/控制和结果的格式来提出研究问题。我们进行了四轮德尔菲调查，参与者提出关键研究问题，然后在9点李克特量表上对问题进行优先级排序，分为低、中、高优先级项目。我们将共识定义为对优先级类别达成≥60%的一致意见，并使用9个类别中的118个研究概念分类法对研究问题进行编码。
结果
31名跨学科主题专家提出了490个研究问题，其中433个（88%）在优先级上达成了共识。这433个问题的排名如下：81个（19%）高优先级，339个（78%）中优先级，13个（3%）低优先级。在81个高优先级问题中，有46个分类概念，包括医疗保健系统（36个问题）、介入性临床试验和比较效果（32个问题）、死亡率作为结果（30个问题）、院前时间/运输方式/急救人员级别（24个问题）、系统基准（17个问题）以及液体/血液制品复苏（17个问题）。
结论
这项关于院前和大规模伤亡护理的德尔菲差距分析确定了81个高优先级研究问题，以指导研究人员和资助机构进行未来的创伤研究。
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