Determining the top research priorities in UK prehospital critical care: a modified Delphi study

Ramage, Lisa; McLachlan, Sarah; Williams, Kristian

doi:10.1136/emermed-2022-212622

Cited by 12 publications

(6 citation statements)

References 17 publications

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“…Recent work has identified the burden of injury from low falls, particularly in the elderly, and indicates that MTC care improves outcomes for those most severely injured [ 21 ], like those included in the present study population. Our work identifies that those with severe injury following a low fall are currently underserved by PHCC resource, and strengthens calls to optimise identification of major trauma and improve PHCC tasking for this group [ 7 , 22 ].…”

Section: Discussionmentioning

confidence: 60%

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The association between geospatial and temporal factors and pre-hospital response to major trauma: a retrospective cohort study in the North of England

McHenry,

Smith

2023

Scand J Trauma Resusc Emerg Med

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Background Major trauma is a leading cause of premature death and disability worldwide, and many healthcare systems seek to improve outcomes following severe injury with provision of pre-hospital critical care. Much research has focussed on the efficacy of pre-hospital critical care and advanced pre-hospital interventions, but less is known about how the structure of pre-hospital critical care services may influence response to major trauma. This study assessed the association between likelihood of pre-hospital critical care response in major trauma and factors important in the planning and development of those services: geographic isolation, time of day, and tasking mechanism. Methods A local trauma registry, supported with data from the Trauma Audit and Research Network alongside additional information regarding pre-hospital management, identified patients sustaining major trauma admitted to Major Trauma Centres in the North of England. Data was extracted on location and time of incident, mechanism of injury, on-scene times, and presence or absence of pre-hospital critical care team. An isochrone map was constructed for 30-minute intervals to regional Major Trauma Centres, defining geographic isolation. Univariate logistic regression compared likelihood of pre-hospital critical care response to that of conventional ambulance response for varying degrees of geographic isolation, day or night period, and mechanism of injury, and multiple linear regression assessed the association between geographic isolation, service response and on-scene time. Results 2619 incidents were included, with 23.3% attended by pre-hospital critical care teams. Compared to conventional ambulance services, pre-hospital critical care teams were more likely to respond major trauma in areas of greater geographic isolation (OR 1.42, 95% CI 1.30–1.55, p < 0.005). There were significant differences in the mechanism of injury attended and no significant difference in response by day or night period. Pre-hospital critical care team response and increasing geographic isolation was associated with longer on-scene times (p < 0.005). Conclusion Pre-hospital critical care teams are more likely to respond to major trauma in areas of greater geographic isolation. Enhanced pre-hospital care may mitigate geographic inequalities when providing advanced interventions and transport of severely injured patients. There may be an unmet need for pre-hospital critical care response in areas close to major hospitals.

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Section: Discussionmentioning

confidence: 60%

“…As PHCC teams are resource-intensive [ 6 ], judicious use of PHCC is important within a trauma system. A recent priority-setting partnership for PHCC has identified important questions regarding service configuration, including in the improvement of PHCC dispatch and comparisons of that of conventional ambulance services [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

The association between geospatial and temporal factors and pre-hospital response to major trauma: a retrospective cohort study in the North of England

McHenry,

Smith

2023

Scand J Trauma Resusc Emerg Med

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“…The scope was defined as relating to adult patients in the ED. Separate research prioritisation has been completed for prehospital emergency care, 18 one is in progress for major trauma and another is planned specifically covering paediatric emergency medicine.…”

Section: Methodsmentioning

confidence: 99%

Refreshing the emergency medicine research priorities

Cottey,

Shanahan,

Gronlund

et al. 2023

Emerg Med J

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BackgroundThe priorities for UK emergency medicine research were defined in 2017 by a priority setting partnership coordinated by the Royal College of Emergency Medicine in collaboration with the James Lind Alliance (JLA). Much has changed in the last 5 years, not least a global infectious disease pandemic and a significant worsening of the crisis in the urgent and emergency care system. Our aim was to review and refresh the emergency medicine research priorities.MethodsA steering group including patients, carers and healthcare professionals was established to agree to the methodology of the refresh. An independent adviser from the JLA chaired the steering group. The scope was adult patients in the ED. New questions were invited via an open call using multiple communications methods ensuring that patients, carers and healthcare professionals had the opportunity to contribute. Questions underwent minisystematic (BestBETs) review to determine if the question had been answered, and the original 2017 priorities were reviewed. Any questions that remained unanswered were included in an interim prioritisation survey, which was distributed to patients, carers and healthcare professionals. Rankings from this survey were reviewed by the steering group and a shortlist of questions put forward to the final workshop, which was held to discuss and rank the research questions in order of priority.Results77 new questions were submitted, of which 58 underwent mini-systematic review. After this process, 49 questions (of which 32 were new, 11 were related to original priorities and 6 unanswered original priorities were carried forward) were reviewed by the steering group and included in an interim prioritisation survey. The interim prioritisation survey attracted 276 individual responses. 26 questions were shortlisted for discussion at the final prioritisation workshop, where the top 10 research priorities were agreed.ConclusionWe have redefined the priorities for emergency medicine research in the UK using robust and established methodology, which will inform the agenda for the coming years.

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“…We thank Mark Hodkinson1 for his encouraging comments regarding our recently published modified Delphi study and we agree that the output will help to expand the evidence base underlying prehospital critical care delivery 2…”

mentioning

confidence: 89%