National Trauma Research Research Articles

ThP7.2 - Nonoperative versus Operative Management in Traumatic Liver Injuries: A Prospective LiPTA Multicentre Study

Abstract Aims The liver is the most injured abdominal organ, with subsequent significant morbidity and mortality. Over the last 30-years liver trauma management has changed, with an increase in nonoperative versus operative approaches. However, contemporary UK data on how liver trauma is managed is limited. Methods This prospective, multicentre audit was conducted through the National Trauma Research and Innovation Collaborative at 18 participating major trauma centres and units across the UK between 01/01/2021-01/10/2021. Differences in demographics, physiology, injury mechanisms, complications, length of stay, and 30-day mortality were compared between patients undergoing definitive nonoperative, including interventional radiology, or operative management. Univariable tests were used to compare data where appropriate with adjusted odds ratios of 30-day mortality used to assess definitive management via a multivariable model. Results Of 266 patients, 76.69% underwent nonoperative management. Operative patients were significantly younger, median age 29 (IQR 20-41) vs. 34 (IQR 23-52) p=0.0146, sustained more penetrating compared to blunt injuries (62.90% vs. 9.80%, p<0.0001), had more active bleeding on CT (32.65% vs. 5.97%, p<0.0001), required massive transfusions (27.42% vs. 8.33%, p=0.0001), sustained more inpatient complications (29.03% vs. 1.96%, p<0.001) and more physiologically unstable on admission. Operative compared to nonoperative management resulted in a significant 20-fold increase in 30-day mortality, (aOR 20.21, 95%CI 3.28-124.43, p=0.001). Conclusions These findings highlight the current approach to UK liver trauma management. Patients undergoing operative management have significantly greater morbidity and mortality yet may represent the severest of liver injures. Where appropriate nonoperative management should be used following liver trauma to reduce this.

Mental Health Support Is an Unmet Need for Long-term Burn Survivors: A Web-based Survey.

A National Trauma Research Action Plan identified the involvement of burn survivors as critical informants to determine the direction of research. This study employed a web-based survey to identify care gaps in a sample of burn survivors. We surveyed burn survivors from around the United States through social media and email contact with the Phoenix Society for Burn Survivors. We elicited demographic info, burn history, and unmet needs. Statistical analysis was performed to test our hypothesis that lack of access to mental health support/professionals would be identified as an unmet need in long-term burn survivors. Of 178 survey respondents, most were at least 10 years removed from the date of their burn injury (n = 94, 53%). Compared with those less than 3 years from their burn injury, individuals greater than 10 years were at least 5 times more likely to note a lack of access to mental health support [11-20 years OR 8.7, P < .001; >20 years OR 5.7, P = .001]. About 60% of Spanish speakers reported lack of support group access was among their greatest unmet needs, compared with 37% of English speakers (P = .184). This study highlights the need for ongoing access to mental health resources in burn survivors. Our findings emphasize that burn injury is not just an acute ailment, but a complex condition that evolves into a chronic disease. Additional studies should focus on the experiences of Spanish-speaking burn survivors, given small sample size leading to a likely clinically significant but not statistically different lack of access to support groups.

Research priorities in tranexamic acid after trauma: Secondary analysis of the National Trauma Research Action Plan.

Tranexamic acid (TXA) is an antifibrinolytic drug that is used in traumatic hemorrhage and traumatic brain injury. Although TXA is considered relatively safe and inexpensive and is widely available, data regarding its mechanisms, optimal dosing, and timing, as well as relative risks and benefits for different patient populations, are inconsistent. In this study, we aim to identify and summarize consensus research questions related to TXA across all National Trauma Research Action Plan (NTRAP) Delphi expert panels to identify priorities for future research on TXA in trauma. A secondary analysis was performed using consensus-based research priorities collected by 11 NTRAP topic panels using a Delphi methodology. The database of questions was queried for the keywords "tranexamic" and "TXA." The identified questions were sorted by subject matter and summarized. Seven panels included a total of 73 TXA-related questions. Forty-six questions reached consensus. The most addressed topic was outcomes (discussed in 64% of questions) followed by indications (49%) and specific patient populations (38%). Because of overlap across panels, questions were summarized and sorted by topic resulting in 21 priority research questions. Seventy-three total questions and 46 questions reaching consensus were identified by NTRAP panelists. The key topics identified in these questions should be prioritized in future funded research on TXA in trauma. Prognostic and Epidemiological; Level V.

An executive summary of the National Trauma Research Action Plan.

The National Trauma Research Action Plan project successfully engaged multidisciplinary experts to define opportunities to advance trauma research and has fulfilled the recommendations related to trauma research from the National Academies of Sciences, Engineering and Medicine report. These panels identified more than 4,800 gaps in our knowledge regarding injury prevention and the optimal care of injured patients and laid out a priority framework and tools to support researchers to advance this field. Trauma research funding agencies and researchers can use this executive summary and supporting manuscripts to strategically address and close the highest priority research gaps. Given that this is the most significant public health threat facing our children, young adults, and military service personnel, we must do better in prioritizing these research projects for funding and providing grant support to advance this work. Through the Coalition for National Trauma Research, the trauma community is committed to a coordinated, collaborative approach to address these critical knowledge gaps and ultimately reduce the burden of morbidity and mortality faced by our patients.

O65: Extremity Trauma in the UK (UK): Vascular Interventions and Surgery in Trauma Audit (VISTA)

Abstract Background Extremity injury is the commonest form of vascular trauma but currently there is no national surgical surveillance of operative management and amputation rates. Vascular injury impacts both the young and elderly, with time critical, trauma specific intervention key for limb salvage. Methods Subgroup analysis of a six-month multicentre, prospective audit of vascular injuries to examine procedures for extremity vascular trauma at 27 UK Major Trauma Centres conducted by the National Trauma Research &amp; Innovation Collaborative and Vascular &amp; Endovascular Research Network. Results There were 153 extremity vascular injuries (n=120 patients: 66 upper limb, 81 lower limb) with 92 primary interventions performed (n=86 open: primary repair, bypass or ligation vs. n=6 endovascular). The median age of operated patients was 36 (IQR: 22.5 - 52) years and 74% were male. 51% of injuries operated upon were secondary to blunt trauma with concomitant orthopaedic injury in 33%. Median time to intervention was 169 (IQR: 112 - 371) minutes with a consultant vascular surgeon present in 84% of cases. Overall, there were n=16 amputations: 7% primary and 11% secondary in operative cases. The median age for amputation was 41.5 (IQR: 36 - 52) years. Conclusion Extremity vascular interventions, regardless of aetiology, require national surveillance to assess outcomes and identify targets for improved limb salvage across all UK vascular and trauma networks.

O64: Aortic Trauma in the UK (UK): Vascular Interventions and Surgery in Trauma Audit (VISTA)

Abstract Background In the UK, the incidence, treatment strategies and clinical outcomes for aortic injury are unknown. Stent graft sizing can be challenging in the acute trauma setting which may increase the risk of stent graft complications. VISTA aimed to describe the UK burden and treatment of aortic trauma. Methods Subgroup analysis of a six-month multicentre, prospective audit of vascular injuries at 27 UK Major Trauma Centres by the National Trauma Research &amp; Innovation Collaborative and Vascular &amp; Endovascular Research Network. Results In total, 58 aortic injuries (43 thoracic, 15 abdominal) with 24 interventions (n=23 TEVAR) were analysed. The median age of TEVAR patients was 46 (IQR: 27 - 59) years and 92% were male. The median time to intervention was 288 (IQR: 208 - 722) minutes and 75% of cases were performed for grade 3 and 4 aortic injuries with one simultaneous carotid-subclavian bypass. A consultant vascular surgeon was documented as present in 75% of cases and the post-procedure mortality rate was 8%. Conclusion TEVARs performed for vascular trauma setting are currently excluded from the National Vascular Registry. UK centre performance, device surveillance and long-term outcomes for this patient cohort requires national monitoring to assure patient safety and drive care quality improvements.

Developing a National Trauma Research Action Plan: Results from the regulatory challenges Delphi survey.

In 2016, the National Academies of Sciences, Engineering, and Medicine issued a report calling for a National Trauma Research Action Plan (NTRAP) requiring a resourced, coordinated, joint approach to trauma care research. The National Academies of Sciences, Engineering, and Medicine report recommended the identification of regulatory barriers to trauma research. The NTRAP Regulatory Challenges Panel of trauma researchers and regulatory professionals was convened to identify the most challenging aspects of regulatory processes involved in conducting research. Trauma researchers and regulatory experts were recruited to identify and rate challenging regulatory issues in 2021 to 2022. Challenge statements were developed from a comprehensive scoping review. Panelists rated the challenge level for each statement on a 9-point Likert scale. The Delphi survey was conducted over three online rounds. Consensus was defined a priori as ≥60% agreement. Results of the Delphi survey were presented to the panel during a webinar. Panel participants then participated in breakout sessions to strategize solutions, share lessons learned, and identify where more regulatory guidance is needed. Thirty-eight subject matter experts rated 175 regulatory challenges, of which 141 (81%) reached the consensus threshold. Of the consensus-reaching challenge statements, 42 had a challenge rating of 6 or higher. Among the highest-rated challenges were issues pertaining to conducting prehospital research, exception from informed consent, mistrust of research among various racial and ethnic groups, and issues specific to conducting pediatric trauma research. This Delphi survey rated challenges culled from a regulatory literature scoping review. The panel identified the most challenging aspects of human subjects protection while conducting trauma research and recommended strategies and best practices to address them. The findings from this study were used to develop the NTRAP Investigator Toolkit, which is available on the internet as a resource for trauma researchers. Prognostic and Epidemiological; Level IV.

EGS P08 The effect of socioeconomic status on traumatic liver injuries: A prospective multicentre study

Abstract Background Abdominal traumas only represent 10% of all trauma-related injuries but is associated with significant morbidity and mortality. This is especially true for liver and pancreatic injuries. There is a growing interest in understanding the complex relationships between socioeconomic deprivation and trauma in recent years. Evidence from the US demonstrates that social deprivation is strongly associated with violent traumas and more severe injuries. There is, however, a lack of research examining the relationship between socioeconomic deprivation and severe abdominal traumas. This prospective multicentre audit investigates the association between socioeconomic status and the mechanisms and outcomes of liver and pancreatic traumas. Methods This prospective, multicentre audit was conducted through the National Trauma Research and Innovation Collaborative at18 participating major trauma centres and units in the United Kingdom between 01/01/2021 and 01/10/2021. The differences in patient demographics, mechanism of injury, injury severity score, operative management, length of hospital stay, and mortality were compared between patients from the five socioeconomic groups. The socioeconomic status for each patient was determined using the Index of Multiple Deprivation (IMD) tool, which is a recognised and validated tool published by the UK government. Chi-squared, Fisher’s Exact, and Kruskal-Wallis tests were used to compare categorical variables as appropriate. Results Of the 232 patients included, 75% were male. There is an increasing trend of deprivation in males, with 82.9% of the most deprived patients being male compared to the 66.7% in the least deprived quintile. The most deprived group had a lower comorbidity burden and were younger with a median age of 26 (IQR 19-39) compared to the least deprived group (median age 42, IQR 28-61,p&amp;lt;0.01). Penetrating injuries occurred more frequently in the 3 most deprived groups, although this was not significant (p=0.09). There were no differences in the management, length of stay, and mortality between the 5 socioeconomic groups. Conclusions The findings of this prospective study adds to the growing body of evidence associating socioeconomic deprivation and major trauma in the UK. Despite the differences in patient demographics across the socioeconomic groups, the definitive management and mortality did not differ. The planning and provision of preventative public health intervention should target areas of higher socioeconomic deprivation.

68 The Diurnal and Seasonal Relationships of Young Pedestrian Injuries Secondary to Motor Vehicles

Abstract Aim There remains a significant morbidity and mortality in young pedestrians hit by motor vehicles. The of this study was to compare the incidence and injury severity of motor vehicle-related pedestrian trauma according to time of day and season in a young population. Method Data was retrieved from the National Trauma Audit and Research Network (TARN) database for patients between 10-25 years old who had been involved as pedestrians in motor vehicle accidents between 2013 -2020. The incidence of injuries, their severity (using the Injury Severity Score [ISS]), and mortality were analysed according to the hours of daylight, darkness, and season. Results The study identified a seasonal pattern, highlighting that injuries were most prevalent during autumn (34.9% of injuries). Prevalence decreased throughout the year from winter (25.4%) to summer (18.3%). The greatest incident rate (number of incidents/hour) occurred between 1500-1630hrs, correlating to school pick up times. A significant relationship between ISS and daylight hours was demonstrated (p-value = 0.0124), whereby moderate injuries (ISS score: 9-15) were more likely during the day (72.7%), while severe injuries (ISS Score &amp;gt; 15) were more likely at night (55.8%). Conclusions We identified a relationship between the time of day and the frequency and severity of pedestrian trauma in young people. In addition, particular time groupings correspond to the greatest incidents rate, suggesting that reduced visibility coupled with school pick up times play a significant role. We recommend targeted public health measures to improve road safety that focus on these high-risk times of the day.

Research Priorities in Venous Thromboembolism after Trauma: Secondary Analysis of the National Trauma Research Action Plan (NTRAP).

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality during recovery from injury and can result in significant healthcare costs. Despite advances in the past several decades in our approach to VTE prophylaxis after injury, opportunities exist to improve the delivery and implementation of optimal VTE prophylaxis. Here, we aim to identify consensus research questions related to VTE across all NTRAP Delphi expert panels to further guide the research agenda aimed at preventing VTE after injury. This is a secondary analysis of consensus-based research priorities that were collected using a Delphi methodology by 11 unique NTRAP panels that were charged with unique topic areas across the spectrum of injury care. The database of questions was queried for the keywords "VTE", "venous thromboembo", and "DVT", then grouped into relevant topic areas. There were 86 VTE-related research questions identified across 9 NTRAP panels. 85 questions reached consensus with 24 rated high priority, 60 medium priority and 1 low priority. Questions related to the timing of VTE prophylaxis (n = 17) were most common, followed by questions related to risk factors for the development of VTE (n = 16), the effects of tranexamic acid on VTE (n = 11), the approach to dosing of pharmacologic prophylaxis (n = 8), as well as the pharmacologic prophylactic medication choice for optimal VTE prophylaxis (n = 6). NTRAP panelists identified 85 consensus-based research questions that should drive dedicated extramural research funding opportunities to support quality studies aimed at optimizing VTE prophylaxis after injury. Original Research, IV.

Multiple trauma in pregnant women: injury assessment, fetal radiation exposure and mortality. A multicentre observational study

BackgroundFetal radiation exposure in pregnant women with trauma is a concern. The purpose of this study was to evaluate fetal radiation exposure with regard to the type of injury assessment performed.MethodsIt is a multicentre observational study. The cohort study included all pregnant women suspected of severe traumatic injury in the participating centres of a national trauma research network. The primary outcome was the cumulative radiation dose (mGy) received by the fetus with respect to the type of injury assessment initiated by the physician in charge of the pregnant patient. Secondary outcomes were maternal and fetal morbi-mortality, the incidence of haemorrhagic shock and the physicians’ imaging assessment with consideration of their medical specialty.ResultsFifty-four pregnant women were admitted for potential major trauma between September 2011 and December 2019 in the 21 participating centres. The median gestational age was 22 weeks [12–30]. 78% of women (n = 42) underwent WBCT. The remaining patients underwent radiographs, ultrasound or selective CT scans based on clinical examination. The median fetal radiation doses were 38 mGy [23–63] and 0 mGy [0–1]. Maternal mortality (6%) was lower than fetal mortality (17%). Two women (out of 3 maternal deaths) and 7 fetuses (out of 9 fetal deaths) died within the first 24 h following trauma.ConclusionsImmediate WBCT for initial injury assessment in pregnant women with trauma was associated with a fetal radiation dose below the 100 mGy threshold. Among the selected population with either a stable status with a moderate and nonthreatening injury pattern or isolated penetrating trauma, a selective strategy seemed safe in experienced centres.

The diurnal and seasonal relationships of pedestrian injuries secondary to motor vehicles in young people

Introduction There remains a significant morbidity and mortality in young pedestrians hit by motor vehicles, even in the era of pedestrian crossings and speed limits. The aim of this study was to compare the incidence and injury severity of motor vehicle-related pedestrian trauma according to time of day and season in a young population, based on the supposition that injuries would be more prevalent during dusk and dawn and during autumn and winter. Methods Data were retrieved from the National Trauma Audit and Research Network (TARN) database for patients between 10 and 25 years old who had been involved as pedestrians in road traffic collisions between 2013 and 2020. The incidence of injuries, their severity (using the injury severity score (ISS)) and mortality were analysed according to the hours of daylight, darkness and season. Results The study identified a seasonal pattern, highlighting that injuries were most prevalent during autumn (34.9% of injuries). Prevalence decreased throughout the year from winter (25.4%) to spring (21.4%), to summer (18.3%). The greatest incident rate (number of incidents/hour) occurred between 1500–1630 h, correlating to school pick up times, but overall there was no significant difference in injury prevalence between hours of darkness (47.3%) and daylight (52.7%). However, a significant relationship between ISS and daylight hours was demonstrated ( p-value = 0.0124), whereby moderate injuries (ISS score: 9–15) were more likely during the day (72.7%), while severe injuries (ISS score &gt; 15) were more likely at night (55.8%). Conclusion We identified a relationship between the time of day and the frequency and severity of pedestrian trauma in young people. In addition, particular time groupings correspond to the greatest incidents rate, suggesting that reduced visibility coupled with school pick up times play a significant role. We recommend targeted public health measures to improve road safety that focus on these high-risk times of the day.

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

The National Academies of Sciences, Engineering, and Medicine 2016 report on the trauma care system recommended establishing a National Trauma Research Action Plan to strengthen and guide future trauma research. To address this recommendation, the Department of Defense funded a study to generate a comprehensive research agenda spanning the trauma and burn care continuum. Panels were created to conduct a gap analysis and identify high-priority research questions. The National Trauma Research Action Plan panel reported here addressed trauma systems and informatics. Experts were recruited to identify current gaps in trauma systems research, generate research questions, and establish the priorities using an iterative Delphi survey approach from November 2019 through August 2020. Panelists were identified to ensure heterogeneity and generalizability, including military and civilian representation. Panelists were encouraged to use a PICO format to generate research questions: patient/population, intervention, compare/control, and outcome. In subsequent surveys, panelists prioritized each research question on a 9-point Likert scale, categorized as low-, medium-, and high-priority items. Consensus was defined as ≥60% agreement. Twenty-seven subject matter experts generated 570 research questions, of which 427 (75%) achieved the consensus threshold. Of the consensus reaching questions, 209 (49%) were rated high priority, 213 (50%) medium priority, and 5 (1%) low priority. Gaps in understanding the broad array of interventions were identified, including those related to health care infrastructure, technology products, education/training, resuscitation, and operative intervention. The prehospital phase of care was highlighted as an area needing focused research. This Delphi gap analysis of trauma systems and informatics research identified high-priority research questions that will help guide investigators and funding agencies in setting research priorities to continue to work toward Zero Preventable Deaths after trauma. Therapeutic/Care Management; Level IV.

Proceedings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma.

On May 4 and 5, 2022, a meeting of multidisciplinary stakeholders in the prevention and treatment of venous thromboembolism (VTE) after trauma was convened by the Coalition for National Trauma Research, funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health, and hosted by the American College of Surgeons in Chicago, Illinois. This consensus conference gathered more than 40 in-person and 80 virtual attendees, including trauma surgeons, other physicians, thrombosis experts, nurses, pharmacists, researchers, and patient advocates. The objectives of the meeting were twofold: (1) to review and summarize the present state of the scientific evidence regarding VTE prevention strategies in injured patients and (2) to develop consensus on future priorities in VTE prevention implementation and research gaps.To achieve these objectives, the first part of the conference consisted of talks from physician leaders, researchers, clinical champions, and patient advocates to summarize the current state of knowledge of VTE pathogenesis and prevention in patients with major injury. Video recordings of all talks and accompanying slides are freely available on the conference website ( https://www.nattrauma.org/research/research-policies-templates-guidelines/vte-conference/ ). Following this curriculum, the second part of the conference consisted of a series of small-group breakout sessions on topics potentially requiring future study. Through this process, research priorities were identified, and plans of action to develop and undertake future studies were defined.The 2022 Consensus Conference to Implement Optimal VTE Prophylaxis in Trauma answered the National Trauma Research Action Plan call to define a course for future research into preventing thromboembolism after trauma. A multidisciplinary group of clinical champions, physicians, scientists, and patients delineated clear objectives for future investigation to address important, persistent key knowledge gaps. The series of papers from the conference outlines the consensus based on the current literature and a roadmap for research to answer these unanswered questions.

EGS P01 The diurnal and seasonal relationships of pedestrian injuries secondary to motor vehicles in young people

Abstract Background There remains a significant morbidity and mortality in young pedestrians hit by motor vehicles, even in the era of pedestrian crossings and speed limits. The aim of this study was to compare incidence and injury severity of motor vehicle-related pedestrian trauma according to time of day and season in a young population, based on the supposition that injuries would be more prevalent during dusk and dawn and during autumn and winter. Methods Data was retrieved for patients between 10–25 years old from the national Trauma Audit and Research Network (TARN) database, who had been involved as pedestrians in motor vehicle accidents between 2015–2020. The incidence of injuries, their severity (using the Injury Severity Score [ISS]), hospital transfer time and mortality were analysed according to the hours of daylight, darkness and season. Results The study identified a seasonal pattern, showing that autumn was the predominant season and lead to 34.9% of injuries, with a further 25.4% in winter in comparison to spring and summer, with 21.4% and 18.3% of injuries respectively. However, visibility alone was not a sufficient factor as 49.5% of injuries occurred during time of darkness, while 50.5% occurred during daylight. Importantly, the greatest injury rate (number of injuries/hour) occurred between 1500–1630 correlating to school pick up times. A further significant relationship between injury severity score (ISS) and daylight was demonstrated (p-value= 0.0124) with moderate injuries (ISS 9–14) occurring most commonly during the day (72.7%) and more severe injuries (ISS&amp;gt;15) occurred during the night (55.8%). Conclusions We have identified a relationship between time of day and the frequency and severity of pedestrian trauma in young people. In addition, particular time groupings correspond to the greatest injury rate, suggesting that reduced visibility coupled with school pick up times may play a significant role . This could be addressed through a targeted public health approach to implement change. We recommend targeted public health measures to improve road safety that focus on these times and that increase the visibility of children combined with education for drivers.

Trauma emergency thoracotomy for resuscitation in shock—a multi-centre evaluation of current UK practice of pre-hospital and emergency department resuscitative thoracotomy in trauma

Abstract Background Resuscitative thoracotomy (RT) in traumatic cardiac arrest, in particular for penetrating trauma features within several national guidelines. However, evidence surrounding its practice is poor, consisting of predominantly small-scale observational studies. Survival is generally poor, estimated at 3–13%, with better outcomes in penetrating trauma. There is no national RT database and the Trauma Audit Research Network data misses those who have died pre-hospital. It is important that a more in-depth and accurate national picture of thoracotomy practice is developed nationally to guide future practice. Traumatic emergency thoracotomy for resuscitation in shock (TETRiS) is a multi-centre, prospective and observational evaluation of current RT practice in the UK. Aims and objectives The aim of TETRiS is to evaluate the pathway of care for RT patients within the UK. This will be undertaken over a period of 12 months. This project will evaluate thoracotomies undertaken both pre-hospital and in emergency departments, examining various parameters including frequency, who performs the procedure, clinical indications, time from injury to initiation, mechanism of injury, injuries identified, interventions performed and patient outcomes. Methods This project is being conducted as a collaboration between the National Trauma Research and Innovation Collaborative, the Pre-Hospital Trainee Operated Research Network, the Trainee Emergency Research Network and the National HEMS Research and Audit Forum (NHRAF). All UK HEMS, helicopter emergency medicine services and major trauma centre (MTCs) nationally have been recruited, with site investigators identified within each participating unit. Inclusion criteria: All patients undergoing RT, pre-hospital or in an MTC emergency department will be included.

Developing a National Trauma Research Action Plan: Results from the long-term outcomes research gap Delphi survey.

In the National Academies of Sciences, Engineering, and Medicine 2016 report on trauma care, the establishment of a National Trauma Research Action Plan to strengthen and guide future trauma research was recommended. To address this recommendation, 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. We describe the gap analysis and high-priority research questions generated from the National Trauma Research Action Plan panel on long-term outcomes. Experts in long-term outcomes were recruited to identify current gaps in long-term trauma outcomes research, generate research questions, and establish the priority for these questions using a consensus-driven, Delphi survey approach from February 2021 to August 2021. Panelists were identified using established Delphi recruitment guidelines to ensure heterogeneity and generalizability including both military and civilian representation. Panelists were encouraged to use a PICO format to generate research questions: Patient/Population, Intervention, Compare/Control, and Outcome model. On subsequent surveys, panelists were asked to prioritize each research question on a 9-point Likert scale, categorized to represent low-, medium-, and high-priority items. Consensus was defined as ≥60% of panelists agreeing on the priority category. Thirty-two subject matter experts generated 482 questions in 17 long-term outcome topic areas. By Round 3 of the Delphi, 359 questions (75%) reached consensus, of which 107 (30%) were determined to be high priority, 252 (70%) medium priority, and 0 (0%) low priority. Substance abuse and pain was the topic area with the highest number of questions. Health services (not including mental health or rehabilitation) (64%), mental health (46%), and geriatric population (43%) were the topic areas with the highest proportion of high-priority questions. This Delphi gap analysis of long-term trauma outcomes research identified 107 high-priority research questions that will help guide investigators in future long-term outcomes research. Diagnostic Tests or Criteria; Level IV.

Developing a National Trauma Research Action Plan: Results from the postadmission critical care research gap Delphi survey.

The 2016 National Academies of Science, Engineering and Medicine report included a proposal to establish a National Trauma Research Action Plan. In response, 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 from prehospital care to rehabilitation as part of an overall strategy to achieve zero preventable deaths and disability after injury. The Postadmission Critical Care Research panel was 1 of 11 panels constituted to develop this research agenda. We recruited interdisciplinary experts in surgical critical care and recruited them to identify current gaps in clinical critical care research, generate research questions, and establish the priority of these questions using a consensus-driven Delphi survey approach. The first of four survey rounds asked participants to generate key research questions. On subsequent rounds, we asked survey participants to rank the priority of each research question on a 9-point Likert scale, categorized to represent low-, medium-, and high-priority items. Consensus was defined as ≥60% of panelists agreeing on the priority category. Twenty-five subject matter experts generated 595 questions. By Round 3, 249 questions reached ≥60% consensus. Of these, 22 questions were high, 185 were medium, and 42 were low priority. The clinical states of hypovolemic shock and delirium were most represented in the high-priority questions. Traumatic brain injury was the only specific injury pattern with a high-priority question. The National Trauma Research Action Plan critical care research panel identified 22 high-priority research questions, which, if answered, would reduce preventable death and disability after injury. Diagnostic Tests or Criteria; Level IV.

Use of a national trauma registry to target violence reduction initiatives

BackgroundThe incidence of interpersonal violence resulting in penetrating traumatic injury has increased in the UK. Violence reduction initiatives vary across the world, from reactive diversionary schemes to proactive educational intervention. To be successful a collaborative public health approach to violence reduction is vital. We examined regional data collected in a trauma network area as part of mandatory national trauma data submission to establish whether useful data could be extracted from this type of registry to inform regional violence reduction initiatives. Key information required to accurately target initiatives includes: who are the victims? where do incidents occur? and when do incidents occur? MethodsData were obtained from the national Trauma Audit and Research Network (TARN). This study utilised TARN inclusion criteria. Data for penetrating trauma patients from hospital sites in the Severn Major Trauma Network over an eight-year period were included in the analysis (1 June 2012 to 5 April 2020). The data were analysed using SPSS Statistics V27 and TARN analytics software. Existing ethical approval for anonymised registry data (PIAG section 60) was used. ResultsOver the eight-year study period, 299 cases of penetrating trauma were registered in the Major Trauma Network. Overall, the incidence of penetrating trauma is increasing (R value +0.470, and +0.900 when 2020 excluded). Male victims account for 87.3% of cases (n=261). Younger individuals are more likely to be victims of penetrating trauma. The proportion of victims aged 13-18 years increased from 0% in 2012 to 21.6% in 2019. There were 43 (14.3%) incidents of victims presenting more than once during the study period. The early evening and hour after midnight had the highest numbers of penetrating trauma incidents. Most incidents occurred in a small proportion of postcodes. All the postcodes identified as having high incidence of penetrating injuries were also areas with high deprivation. ConclusionThis study demonstrated that national trauma registry data can be used to establish valuable information about serious penetrating trauma in a region. This data provides key information with which to target a proactive approach to violence reduction in our region with implications for public health, police, and clinical policymakers.

Developing a National Trauma Research Action Plan: Results from the injury prevention research gap Delphi survey.

In its 2016 report on trauma care, the National Academies of Sciences, Engineering, and Medicine called for the establishment of a National Trauma Research Action Plan to strengthen and guide future trauma research. To address this recommendation, 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. We describe the gap analysis and high priority research questions generated from the National Trauma Research Action Plan panel on injury prevention. Experts in injury prevention research were recruited to identify current gaps in injury prevention research, generate research questions and establish the priority of these questions using a consensus-driven Delphi survey approach from December 2019 through September 2020. Participants were identified using established Delphi recruitment guidelines to ensure heterogeneity and generalizability with both military and civilian representatives. Participants were encouraged, but not required, to use a Patient/Population, Intervention, Comparison, and Outcome format to generate research questions: Patient/Population; Intervention; Compare/Control; Outcome model. On subsequent surveys, participants were asked to rank the priority of each research question on a nine-point Likert scale, categorized to represent low-, medium-, and high-priority items. Consensus was defined as 60% or greater of panelists agreeing on the priority category. Twenty-eight subject matter experts generated 394 questions in 12 topic areas. By round 3 of the Delphi, 367 (93.1%) questions reached consensus, of which 169 (46.1%) were determined to be high priority, 196 (53.4%) medium priority, and 2 (0.5%) low priority. Among the 169 high priority questions, suicide (29.6%), firearm violence (20.1%), and violence prevention (18.3%) were the most prevalent topic areas. This Delphi gap analysis of injury prevention research identified 169 high priority research questions that will help guide investigators in future injury prevention research. Funding agencies and researchers should consider these gaps when they prioritize future research. Therepeutic/Care Management; Level IV.