欧洲创伤与急诊外科学会成员确定的急诊外科研究重点:未来临床研究机会路线图

European society for trauma and emergency surgery member-identified research priorities in emergency surgery: a roadmap for future clinical research opportunities.

作者信息

Bass Gary Alan, Kaplan Lewis Jay, Gaarder Christine, Coimbra Raul, Klingensmith Nathan John, Kurihara Hayato, Zago Mauro, Cioffi Stefano Piero Bernardo, Mohseni Shahin, Sugrue Michael, Tolonen Matti, Valcarcel Cristina Rey, Tilsed Jonathan, Hildebrand Frank, Marzi Ingo

机构信息

Division of Traumatology, Emergency Surgery and Surgical Critical Care, Perelman School of Medicine, University of Pennsylvania, 51 N. 39th Street, MOB 1, Suite 120, Philadelphia, PA, 19104, USA.

Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, PA, USA.

出版信息

Eur J Trauma Emerg Surg. 2024 Apr;50(2):367-382. doi: 10.1007/s00068-023-02441-3. Epub 2024 Feb 27.

Abstract

BACKGROUND

European Society for Trauma and Emergency Surgery (ESTES) is the European community of clinicians providing care to the injured and critically ill surgical patient. ESTES has several interlinked missions - (1) the promotion of optimal emergency surgical care through networked advocacy, (2) promulgation of relevant clinical cognitive and technical skills, and (3) the advancement of scientific inquiry that closes knowledge gaps, iteratively improves upon surgical and perioperative practice, and guides decision-making rooted in scientific evidence. Faced with multitudinous opportunities for clinical research, ESTES undertook an exercise to determine member priorities for surgical research in the short-to-medium term; these research priorities were presented to a panel of experts to inform a 'road map' narrative review which anchored these research priorities in the contemporary surgical literature.

METHODS

Individual ESTES members in active emergency surgery practice were polled as a representative sample of end-users and were asked to rank potential areas of future research according to their personal perceptions of priority. Using the modified eDelphi method, an invited panel of ESTES-associated experts in academic emergency surgery then crafted a narrative review highlighting potential research priorities for the Society.

RESULTS

Seventy-two responding ESTES members from 23 countries provided feedback to guide the modified eDelphi expert consensus narrative review. Experts then crafted evidence-based mini-reviews highlighting knowledge gaps and areas of interest for future clinical research in emergency surgery: timing of surgery, inter-hospital transfer, diagnostic imaging in emergency surgery, the role of minimally-invasive surgical techniques and Enhanced Recovery After Surgery (ERAS) protocols, patient-reported outcome measures, risk-stratification methods, disparities in access to care, geriatric outcomes, data registry and snapshot audit evaluations, emerging technologies interrogation, and the delivery and benchmarking of emergency surgical training.

CONCLUSIONS

This manuscript presents the priorities for future clinical research in academic emergency surgery as determined by a sample of the membership of ESTES. While the precise basis for prioritization was not evident, it may be anchored in disease prevalence, controversy around aspects of current patient care, or indeed the identification of a knowledge gap. These expert-crafted evidence-based mini-reviews provide useful insights that may guide the direction of future academic emergency surgery research efforts.

摘要

背景

欧洲创伤与急诊外科学会(ESTES)是为受伤及危重症外科患者提供护理的欧洲临床医生团体。ESTES有多项相互关联的使命——(1)通过网络化宣传促进最佳急诊外科护理;(2)传播相关临床认知和技术技能;(3)推进科学探究,填补知识空白,反复改进外科及围手术期实践,并以科学证据为基础指导决策。面对众多临床研究机会,ESTES开展了一项活动,以确定会员在短期至中期对外科研究的优先事项;这些研究优先事项提交给一个专家小组,以形成一份“路线图”叙述性综述,将这些研究优先事项与当代外科文献相结合。

方法

对积极从事急诊外科实践的ESTES会员个体进行调查,作为最终用户的代表性样本,并要求他们根据个人对优先事项的认知,对未来潜在研究领域进行排序。然后,采用改良的德尔菲法,邀请一组与ESTES相关的学术急诊外科专家撰写一篇叙述性综述,突出该学会潜在的研究优先事项。

结果

来自23个国家的72名ESTES会员做出回应,提供反馈以指导改良的德尔菲专家共识叙述性综述。专家们随后撰写了基于证据的小型综述,突出急诊外科未来临床研究的知识空白和感兴趣的领域:手术时机、医院间转运、急诊外科的诊断成像、微创外科技术和术后加速康复(ERAS)方案的作用、患者报告的结局指标、风险分层方法、获得护理的差异、老年患者结局、数据登记和快照审计评估、新兴技术探究,以及急诊外科培训的提供和基准评估。

结论

本文阐述了由ESTES会员样本确定的学术急诊外科未来临床研究的优先事项。虽然优先排序的确切依据并不明显,但可能基于疾病患病率、当前患者护理方面的争议,或者确实是知识空白的识别。这些由专家精心撰写的基于证据的小型综述提供了有用的见解,可能会指导未来学术急诊外科研究工作的方向。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac3b/11035411/7da65bc00075/68_2023_2441_Fig1_HTML.jpg

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