制定国家创伤研究行动计划：老年研究差距德尔菲调查结果。
Developing a National Trauma Research Action Plan: Results from the geriatric research gap Delphi survey.
机构信息
From the Department of Surgery (B.J., A.T.S.), University of Arizona, College of Medicine, Tucson, Arizona; Department of Biomedical Informatics and Medical Education (J.P., E.S.), The University of Washington, Seattle, Washington; Coalition for National Trauma Research (M.A.B., P.J.B., M.A.P.), San Antonio, Texas; University of South Florida Morsani College of Medicine-Lehigh Valley Campus (R.D.B.), Allentown, Pennsylvania; Brigham & Women's Hospital (Z.C., M.J.), Boston, Massachusetts; Department of Surgery (W.L., E.B.), The Department of Surgery, Trauma and Surgical Critical Care Division (S.L.), Brown University, Providence, Rhode Island; Department of Anesthesiology (E.P.), UTHealth Houston McGovern Medical School, Houston, Texas; Department of Surgery, The Division of Trauma and Critical care (R.D.B.), Lehigh Valley Hospital and Health Network, University of South Florida Morsani College of Medicine (USF-MCOM), Lehigh Valley Campus, Allentown, PA.
出版信息
J Trauma Acute Care Surg. 2022 Aug 1;93(2):209-219. doi: 10.1097/TA.0000000000003626. Epub 2022 Apr 8.
BACKGROUND
Treating older trauma patients requires a focus on the confluence of age-related physiological changes and the impact of the injury itself. Therefore, the primary way to improve the care of geriatric trauma patients is through the development of universal, systematic multidisciplinary research. To achieve this, the Coalition for National Trauma Research has developed the National Trauma Research Action Plan that has generated a comprehensive research agenda spanning the continuum of geriatric trauma care from prehospital to rehabilitation.
METHODS
Experts in geriatric trauma care and research were recruited to identify current gaps in clinical geriatric research, generate research questions, and establish the priority of these questions using a consensus-driven Delphi survey approach. Participants were identified using established Delphi recruitment guidelines ensuring heterogeneity and generalizability. On subsequent surveys, participants were asked to rank the priority of each research question on a nine-point Likert scale, categorized to represent low-, medium-, and high-priority items. The consensus was defined as more than 60% of panelists agreeing on the priority category.
RESULTS
A total of 24 subject matter experts generated questions in 109 key topic areas. After editing for duplication, 514 questions were included in the priority ranking. By round 3, 362 questions (70%) reached 60% consensus. Of these, 161 (44%) were high, 198 (55%) medium, and 3 (1%) low priority.
CONCLUSION
Among the questions prioritized as high priority, questions related to three types of injuries (i.e., rib fracture, traumatic brain injury, and lower extremity injury) occurred with the greatest frequency. Among the 25 highest priority questions, the key topics with the highest frequency were pain management, frailty, and anticoagulation-related interventions. The most common types of research proposed were interventional clinical trials and comparative effectiveness studies, outcome research, and health care systems research.
背景
治疗老年创伤患者需要关注与年龄相关的生理变化和损伤本身的影响的融合。因此，改善老年创伤患者护理的主要方法是通过制定普遍的、系统的多学科研究。为此，国家创伤研究联盟制定了国家创伤研究行动计划，该计划提出了一个全面的研究议程，涵盖了从院前到康复的老年创伤护理的连续体。
方法
招募了老年创伤护理和研究方面的专家，以确定临床老年研究中的当前差距，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。参与者是通过既定的 Delphi 招募指南确定的，以确保异质性和通用性。在随后的调查中，参与者被要求对每个研究问题的优先级进行九点李克特量表的评分，分类代表低、中、高优先级项目。共识定义为超过 60%的小组成员同意优先级类别。
结果
共有 24 名主题专家在 109 个关键主题领域提出了问题。在编辑重复问题后，共有 514 个问题被列入优先级排名。在第 3 轮中，362 个问题（70%）达到了 60%的共识。其中，161 个（44%）为高优先级，198 个（55%）为中优先级，3 个（1%）为低优先级。
结论
在被列为高优先级的问题中，与三种类型的损伤（即肋骨骨折、创伤性脑损伤和下肢损伤）相关的问题出现的频率最高。在 25 个最高优先级问题中，出现频率最高的关键主题是疼痛管理、脆弱和抗凝相关干预。提出的最常见的研究类型是干预性临床试验、比较有效性研究、结果研究和医疗保健系统研究。
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