制定国家创伤研究行动计划：儿科研究差距德尔菲调查结果。
Developing a National Trauma Research Action Plan: Results from the Pediatric Research Gap Delphi Survey.
机构信息
From the Department of Pediatric Surgery (J.I.G.), Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; University of Washington (J.P.), Seattle, Washington; Coalition for National Trauma Research (M.A.P., P.J.B.), San Antonio, Texas; Pediatric Surgery (P.F.E.), University of Michigan Injury Center, Ann Arbor, Michigan; Division of Emergency Trauma and Burn Surgery (R.S.B.), Children's National Hospital, Washington, DC; Department of Surgery (A.R.J.), University of California San Francisco/Benioff Children's Hospital Oakland, Oakland, California; Department of Epidemiology (F.P.R.), University of Washington, Seattle, Washington; Department of Pediatric Neurosurgery (E.A.S.), Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; and Trauma Surgery & Surgical Critical Care (E.M.B.), University of Washington, Seattle, Washington.
出版信息
J Trauma Acute Care Surg. 2022 Sep 1;93(3):360-366. doi: 10.1097/TA.0000000000003610. Epub 2022 Mar 14.
BACKGROUND
In 2016, the National Academies of Sciences, Engineering, and Medicine trauma report recommended a National Trauma Research Action Plan to "strengthen trauma research and ensure that the resources available for this research are commensurate with the importance of injury and the potential for improvement in patient outcomes." With a contract from the Department of Defense, the Coalition for National Trauma Research created 11 expert panels to address this recommendation, with the goal of developing a comprehensive research agenda, spanning the continuum of trauma and burn care. This report outlines the work of the group focused on pediatric trauma.
METHODS
Experts in pediatric trauma clinical care and research were recruited to identify gaps in current clinical pediatric trauma research, generate research questions, and establish the priority of these questions using a consensus-driven Delphi survey approach. Using successive surveys, participants were asked to rank the priority of each research question on a 9-point Likert scale categorized to represent priority. Consensus was defined as >60% agreement within the priority category. Priority questions were coded based on a dictionary of 118 National Trauma Research Action Plan taxonomy concepts in 9 categories to support comparative analysis across all panels.
RESULTS
Thirty-seven subject matter experts generated 625 questions. A total of 493 questions (79%) reached consensus on priority level. Of those reaching consensus, 159 (32%) were high, 325 (66%) were medium, and 9 (2%) were low priority. The highest priority research questions related to surgical interventions for traumatic brain injury (intracranial pressure monitoring and craniotomy); the second highest priority was hemorrhagic shock. The prehospital setting was the highest priority phase of care.
CONCLUSION
This diverse panel of experts determined that most significant pediatric trauma research gaps were in traumatic brain injury, hemorrhagic shock, and the prehospital phase of care. These research domains should be top priorities for funding agencies.
LEVEL OF EVIDENCE
Therapeutic / Care Management; Level IV.
背景
2016 年，美国国家科学院、工程院和医学研究院的创伤报告建议制定一项国家创伤研究行动计划，“加强创伤研究，确保用于这项研究的资源与伤害的重要性以及改善患者预后的潜力相称”。应美国国防部的合同要求，国家创伤研究联盟成立了 11 个专家小组来解决这一建议，目标是制定一个全面的研究议程，涵盖创伤和烧伤护理的各个方面。本报告概述了专注于儿科创伤的小组的工作。
方法
招募了儿科创伤临床护理和研究方面的专家，以确定当前儿科创伤临床研究中的差距，提出研究问题，并使用共识驱动的 Delphi 调查方法确定这些问题的优先级。通过连续的调查，参与者被要求根据 9 分李克特量表对每个研究问题的优先级进行排名，分为优先类别。共识定义为优先类别内的>60%的一致意见。根据 118 个国家创伤研究行动计划分类法中的 9 个类别中的 98 个概念对优先问题进行编码，以支持所有小组之间的比较分析。
结果
37 名主题专家提出了 625 个问题。共有 493 个问题（79%）在优先级上达成共识。在达成共识的问题中，159 个（32%）是高优先级，325 个（66%）是中优先级，9 个（2%）是低优先级。优先级最高的研究问题涉及创伤性脑损伤的手术干预（颅内压监测和开颅术）；其次是出血性休克。院前阶段是护理的最高优先级阶段。
结论
这个由不同专家组成的小组确定，大多数重大儿科创伤研究差距存在于创伤性脑损伤、出血性休克和院前阶段。这些研究领域应该是资助机构的首要重点。
证据水平
治疗/护理管理；四级。
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