Larson A Noelle, Paradkar Ria, Schmitz Matthew, Liu Raymond, Patel Neeraj M, Ellis Henry, Milbrandt Todd A, Sucato Dan, Shea Kevin, Laine Jennifer
Pediatric Orthopedic Society of North America, Oakbrook Terrace, IL, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
J Pediatr Soc North Am. 2025 Jun 4;12:100217. doi: 10.1016/j.jposna.2025.100217. eCollection 2025 Aug.
There is a need for additional high quality studies in children's orthopaedic surgery to answer important clinical research questions. The purpose of this study was to develop a consensus-based research agenda to identify top clinical questions to prioritize in pediatric orthopaedics.
A modified Delphi technique was used, where the membership of the Pediatric Orthopaedic Society of North America (POSNA) was asked to submit clinical research questions and then queried iteratively to gain consensus. A steering committee from the POSNA leadership members was assembled to administer, consolidate, and edit survey responses. Final scores were used to select the top 16 research questions distributed by subspecialty area.
Based on the call for clinical research questions, 78 orthopaedic surgeons and scientists submitted 116 research questions. The steering committee removed duplicate questions and harmonized submissions to 65 clinical research questions. In spring 2024, the POSNA membership participated in stage 1 voting and submitted 33 additional questions. Duplicate questions were removed. The final voting round included 108 surgeons who rated 54 questions from low (1) to high priority (5). The top scoring questions from each subspecialty area were selected to comprise the POSNA consensus-based clinical research agenda. The top scoring questions were related to the role of orthopaedic surgical treatment in cerebral palsy and surgical indications for residual hip dysplasia.
This consensus-based research agenda may guide surgeons, researchers, study group consortia, and funding organizations to improve the clinical evidence in children's orthopaedic surgery and promote high-quality prospective studies.
(1)Despite the significant burden and cost of pediatric musculoskeletal conditions, pediatric orthopaedic research receives low research funding, underscoring the need for a focused research agenda.(2)This study used a modified Delphi process to engage pediatric orthopaedic surgeons across multiple pediatric orthopaedic subspecialties in the development of a consensus-based research agenda in order to identify high-priority clinical questions.(3)The final agenda reflects critical gaps in pediatric orthopaedic care, including conditions that impact long-term function and quality of life in pediatric orthopaedic patients.(4)The final agenda aims to guide future research, foster multicenter collaboration, and advocate optimized allocation of funding to improve evidence-based pediatric orthopaedic care.
Level IV (consensus-based expert opinion study).
儿童骨科手术领域需要更多高质量研究来回答重要的临床研究问题。本研究的目的是制定一个基于共识的研究议程，以确定小儿骨科领域应优先考虑的首要临床问题。
采用改良的德尔菲技术，邀请北美小儿骨科学会（POSNA）成员提交临床研究问题，然后进行反复询问以达成共识。组建了一个由POSNA领导成员组成的指导委员会，负责管理、整合和编辑调查回复。最终得分用于选择按亚专业领域分布的前16个研究问题。
根据对临床研究问题的征集，78名骨科外科医生和科学家提交了116个研究问题。指导委员会删除了重复问题，并将提交内容统一为65个临床研究问题。2024年春季，POSNA成员参与了第一阶段投票，并提交了另外33个问题。重复问题被删除。最终投票轮有108名外科医生参与，他们对54个问题从低优先级（1）到高优先级（5）进行评分。每个亚专业领域得分最高的问题被选中，构成了基于POSNA共识的临床研究议程。得分最高的问题与骨科手术治疗在脑瘫中的作用以及残留髋关节发育不良的手术指征有关。
这个基于共识的研究议程可以指导外科医生、研究人员、研究小组联盟和资助机构，以改善儿童骨科手术的临床证据，并促进高质量的前瞻性研究。
（1）尽管小儿肌肉骨骼疾病负担重且成本高，但小儿骨科研究获得的研究资金较少，这凸显了制定重点研究议程的必要性。（2）本研究采用改良的德尔菲流程，让多个小儿骨科亚专业的小儿骨科外科医生参与制定基于共识的研究议程，以确定高优先级的临床问题。（3）最终议程反映了小儿骨科护理中的关键差距，包括影响小儿骨科患者长期功能和生活质量的病症。（4）最终议程旨在指导未来研究，促进多中心合作，并倡导优化资金分配，以改善循证小儿骨科护理。
IV级（基于共识的专家意见研究）。
