Developing a National Trauma Research Action Plan: Results from the Neurotrauma Research Panel Delphi Survey

Abstract

BACKGROUND:In 2016, the National Academies of Science, Engineering and Medicine called for the development of a National Trauma Research Action Plan. The Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care. Given the public health burden of injuries to the central nervous system, neurotrauma was one of 11 panels formed to address this recommendation with a gap analysis and generation of high-priority research questions. METHODS:We recruited interdisciplinary experts to identify gaps in the neurotrauma literature, generate research questions, and prioritize those questions using a consensus-driven Delphi survey approach. We conducted four Delphi rounds in which participants generated key research questions and then prioritized the importance of the questions on a 9-point Likert scale. Consensus was defined as 60% or greater of panelists agreeing on the priority category. We then coded research questions using an National Trauma Research Action Plan taxonomy of 118 research concepts, which were consistent across all 11 panels. RESULTS:Twenty-eight neurotrauma experts generated 675 research questions. Of these, 364 (53.9%) reached consensus, and 56 were determined to be high priority (15.4%), 303 were deemed to be medium priority (83.2%), and 5 were low priority (1.4%). The research topics were stratified into three groups-severe traumatic brain injury (TBI), mild TBI (mTBI), and spinal cord injury.The number of high-priority questions for each subtopic was 46 for severe TBI (19.7%), 3 for mTBI (4.3%) and 7 for SCI (11.7%). CONCLUSION:This Delphi gap analysis of neurotrauma research identified 56 high-priority research questions. There are clear areas of focus for severe TBI, mTBI, and spinal cord injury that will help guide investigators in future neurotrauma research. Funding agencies should consider these gaps when they prioritize future research.

Saudi Critical Care Society clinical practice guidelines on the prevention of venous thromboembolism in adults with trauma: reviewed for evidence-based integrity and endorsed by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

“…It is uncertain whether such changes in practice impact the relative effectiveness of various prophylactic measures. There is an urgent need for high-quality evidence to guide clinicians involved in the care of adults with trauma [ 109 – 113 ]. Table 2 shows a summary of identified research priorities.…”

Developing a National Trauma Research Action Plan (NTRAP): Results from the Post-Admission Critical Care Research Gap Delphi Survey

“…In addition, both panels had high-priority questions related to viscoelastic-based resuscitation and correction of coagulopathy to improve outcome, with the neurotrauma panel question specific to patients with severe TBI. 33 The lack of greater overlap is explained in part by the focus of the neurotrauma panel on all degrees of TBI severity through the entire trajectory of care and the focus of this panel on systemic issues that affect all critically ill patients.…”

“…There is some expected overlap with the high-priority questions generated by the NTRAP Neurotrauma panel, given that severe traumatic brain injury is commonly treated by many of the experts on both panels. One of the high-priority questions identified by the critical care panel, “In trauma patients with severe traumatic brain injury, should brain tissue oxygenation levels (Licox) be added to traditional management strategies versus traditional management strategies alone to improve mortality, short-term functional outcomes, and long-term functional outcomes?”, overlaps with the neurotrauma research question, “In patients with severe TBI, which adjunct measures (e.g., cerebral oxygenation, pressure reactivity index, cerebral blood flow, cerebral metabolism) serve to best define the optimal CPP?” In addition, both panels had high-priority questions related to viscoelastic-based resuscitation and correction of coagulopathy to improve outcome, with the neurotrauma panel question specific to patients with severe TBI 33 . The lack of greater overlap is explained in part by the focus of the neurotrauma panel on all degrees of TBI severity through the entire trajectory of care and the focus of this panel on systemic issues that affect all critically ill patients.…”

Developing a National Trauma Research Action Plan: Results from the trauma systems and informatics panel Delphi survey

“…14,15 The methodology used by the National Trauma Research Action Plan (NTRAP) panels is described in previous publications. [16][17][18][19][20][21][22] In brief, an Internet-based program, Surveylet (Calibrum, Saint George, UT; https://calibrum.com), was used to administer the Delphi surveys. In Round 0 of this survey, panelists received lists of themes and specific topics related to trauma systems that had been created by the panel leaders and vetted by the NTRAP Steering Committee.…”