Research priorities for the management of major trauma: an international priority setting partnership with the James Lind Alliance

Christopher Patrick Bretherton; Robert Hirst; Hamez Gacaferi; Jonathan Gower; Lauren Exell; Scott Johnston; Shan Martin; Caroline Leech; Catherine Hilton; Ceri Battle; Daniel Axelrod; Heather Vallier; Daphne Van Embden; David J Stockton; Elaine Cole; Julia Williams; Louise Johnson; Maritz Laubscher; Melissa Webb; Philip Braude; Sarah Norris; Steve Bell; Sithombo Maqungo; Xavier Luke Griffin; Major Trauma Priority Setting Partnership Steering Group

doi:10.1136/bmjopen-2023-083450

Research priorities for the management of major trauma: an international priority setting partnership with the James Lind Alliance

BMJ Open. 2024 May 15;14(5):e083450. doi: 10.1136/bmjopen-2023-083450.

Authors

Christopher Patrick Bretherton¹, Robert Hirst², Hamez Gacaferi³, Jonathan Gower⁴, Lauren Exell⁵, Scott Johnston⁶, Shan Martin⁷, Caroline Leech⁸, Catherine Hilton⁵, Ceri Battle⁹, Daniel Axelrod¹⁰, Heather Vallier¹¹, Daphne Van Embden¹², David J Stockton¹³, Elaine Cole¹⁴, Julia Williams¹⁵, Louise Johnson¹⁶, Maritz Laubscher¹⁷, Melissa Webb¹⁸, Philip Braude¹⁹, Sarah Norris²⁰, Steve Bell²¹, Sithombo Maqungo²², Xavier Luke Griffin^{23

24}; Major Trauma Priority Setting Partnership Steering Group

Collaborators

Major Trauma Priority Setting Partnership Steering Group:
Caroline James, Carrol Lamouline, Russell Neighbour, Yesmin Begum, Akshay Patel, Angelos Kolias, Carl Smith, Claire Jackson, Edward Caruana, Fiona Lecky, Gordon Fuller, Ian Greaves, Jacqueline Robson, Justine Theaker, Karim Brohi, Mary Breslin, Michael Wilson, Naomi Davis, Rachel Jenner, Rayner Maayen, Ross Davenport, Sarah Hendrickson, Spencer Wade

Affiliations

¹ Bone and Joint Health, Queen Mary University of London Faculty of Medicine and Dentistry, London, UK c.bretherton@qmul.ac.uk.
² Department of Emergency, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
³ Department of General Surgery, Haaglanden Medisch Centrum Bronovo, Den Haag, The Netherlands.
⁴ James Lind Alliance, Southampton, UK.
⁵ Bone and Joint Health, Queen Mary University of London Faculty of Medicine and Dentistry, London, UK.
⁶ Patient Representative, Yorkshire, UK.
⁷ Patient Representative, Wessex, UK.
⁸ Emergency Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
⁹ Welsh Institute of Biomedical and Emergency Medicine Research, Swansea Bay University Health Board, Port Talbot, UK.
¹⁰ Trauma and Orthopaedics, McMaster University, Hamilton, Ontario, Canada.
¹¹ Case Western Reserve University Hospital, Cleveland, Ohio, USA.
¹² Department of Trauma Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
¹³ Department of Orthopaedics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.
¹⁴ Trauma Sciences, Queen Mary University of London, London, UK.
¹⁵ College of Paramedics, Bridgwater, UK.
¹⁶ Clinical Psychology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁷ Orthopaedic Trauma Service, Division of Orthopaedic Surgery, University of Cape Town Faculty of Health Sciences, Capetown, South Africa.
¹⁸ Alfred Hospital, Melbourne, Victoria, Australia.
¹⁹ CLARITY (Collaborative Ageing Research), North Bristol NHS Trust, Tetbury, UK.
²⁰ Occupational Therapy, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
²¹ Medical Directorate, North West Ambulance Service NHS Trust, Bolton, UK.
²² Orthopaedic Trauma Service, Division of Orthopaedic Surgery, University of Cape Town Faculty of Health Sciences, Observatory, South Africa.
²³ Bone and Joint Health, Barts and The London School of Medicine and Dentistry, London, UK.
²⁴ Trauma and Orthopaedics, Barts and The London NHS Trust, London, UK.

Abstract

Objective: The objective of this study is to determine research priorities for the management of major trauma, representing the shared priorities of patients, their families, carers and healthcare professionals.

Design/setting: An international research priority-setting partnership.

Participants: People who have experienced major trauma, their carers and relatives, and healthcare professionals involved in treating patients after major trauma. The scope included chest, abdominal and pelvic injuries as well as major bleeding, multiple injuries and those that threaten life or limb.

Methods: A multiphase priority-setting exercise was conducted in partnership with the James Lind Alliance over 24 months (November 2021-October 2023). An international survey asked respondents to submit their research uncertainties which were then combined into several indicative questions. The existing evidence was searched to ensure that the questions had not already been sufficiently answered. A second international survey asked respondents to prioritise the research questions. A final shortlist of 19 questions was taken to a stakeholder workshop, where consensus was reached on the top 10 priorities.

Results: A total of 1572 uncertainties, submitted by 417 respondents (including 132 patients and carers), were received during the initial survey. These were refined into 53 unique indicative questions, of which all 53 were judged to be true uncertainties after reviewing the existing evidence. 373 people (including 115 patients and carers) responded to the interim prioritisation survey and 19 questions were taken to a final consensus workshop between patients, carers and healthcare professionals. At the final workshop, a consensus was reached for the ranking of the top 10 questions.

Conclusions: The top 10 research priorities for major trauma include patient-centred questions regarding pain relief and prehospital management, multidisciplinary working, novel technologies, rehabilitation and holistic support. These shared priorities will now be used to guide funders and teams wishing to research major trauma around the globe.

Keywords: accident & emergency medicine; musculoskeletal disorders; trauma management.

MeSH terms

Caregivers
Female
Health Personnel
Health Priorities*
Humans
Male
Multiple Trauma / therapy
Research
Surveys and Questionnaires
Wounds and Injuries / therapy