Department of Anaesthesia, NHS Lanarkshire, University Hospital Wishaw, Netherton Street, Wishaw ML20DP, UK; Centre for Trauma Science Queen Mary University of London Blizard Institute, 4 Newark Street, London E1 2AT, England, UK.
Emergency Department King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, England, UK; Centre for Trauma Science Queen Mary University of London Blizard Institute, 4 Newark Street, London E1 2AT, England, UK.
Injury. 2024 Jan;55(1):110967. doi: 10.1016/j.injury.2023.110967. Epub 2023 Jul 31.
Rib fractures are associated with significant morbidity and mortality, and providing adequate analgesia is paramount in preventing early complications from these injuries. Multiple regional anaesthetic techniques can be used to provide analgesia for these injuries; however, few evidence-based guidelines exist for their use. The aim of this study was to establish consensus within an expert group on the selection criteria used when choosing regional anaesthetic techniques for rib fractures.
The Delphi technique is a mixed-methods study format which uses a longitudinal survey process to develop consensus opinion amongst an expert group. A three-round modified e-Delphi study was undertaken using an online survey platform. Round one established cohort characteristics and identified key factors considered important by the group when selecting regional anaesthetic techniques for rib fractures. Subsequent rounds used Likert scales and free text comments to rate the participants' level of agreement with various statements generated from the first-round responses. The final consensus threshold was established as at least 70% of respondents stating, 'Strongly Disagree' or 'Disagree' or alternatively 'Agree' or 'Strongly Agree'.
An expert panel of UK-based consultants in anaesthesia and/or intensive care medicine was recruited. Participants worked in a variety of tertiary- and non-tertiary trauma care settings and were varied in their years of experience, approximate annual rib fracture caseload and preference for various anaesthetic techniques in rib fracture management. 54 participants took part in round one and generated 60 statements which were further analysed in an iterative process involving a total of three rounds. A total of 28 statements ultimately reached the pre-defined threshold for consensus within the expert group.
This e-Delphi study succeeded in building consensus across multiple statements relating to the selection criteria for regional anaesthesia in patients with rib fractures. These consensus statements can inform clinical practice, guide future research priorities and can be integrated into decision-making pathways across multiple hospital settings.
肋骨骨折与显著的发病率和死亡率相关，为预防这些损伤的早期并发症，提供充分的镇痛至关重要。多种区域麻醉技术可用于为这些损伤提供镇痛；然而，针对其使用，仅有少数循证指南存在。本研究旨在为肋骨骨折的区域麻醉技术选择标准，在专家组内达成共识。
德尔菲法是一种混合方法研究设计，使用纵向调查过程在专家组内达成共识意见。采用三轮改良电子德尔菲研究，使用在线调查平台。第一轮确定队列特征，并确定专家组在选择肋骨骨折区域麻醉技术时考虑的重要因素。随后几轮使用李克特量表和自由文本评论，对各种从第一轮回复中生成的陈述，对参与者的一致程度进行评分。最终共识阈值确定为至少 70%的应答者表示“强烈不同意”或“不同意”，或者“同意”或“强烈同意”。
招募了英国麻醉和/或重症监护医学顾问专家小组。参与者在各种三级和非三级创伤护理环境中工作，其工作经验、每年肋骨骨折的大致病例数和对各种麻醉技术在肋骨骨折管理中的偏好各不相同。54 名参与者参加了第一轮，并生成了 60 条陈述，这些陈述在一个总共三轮的迭代分析过程中进一步进行了分析。共有 28 条陈述最终在专家组内达到了预先定义的共识阈值。
这项电子德尔菲研究成功地在与患者肋骨骨折的区域麻醉选择标准相关的多项陈述中建立了共识。这些共识陈述可以为临床实践提供信息，指导未来的研究重点，并可以整合到多个医院环境中的决策路径中。
