Defining major trauma: a Delphi study
Tóm tắt
Retrospective trauma scores are often used to categorise trauma, however, they have little utility in the prehospital or hyper-acute setting and do not define major trauma to non-specialists. This study employed a Delphi process in order to gauge degrees of consensus/disagreement amongst expert panel members to define major trauma. A two round modified Delphi technique was used to explore subject-expert consensus and identify variables to define major trauma through systematically collating questionnaire responses. After initial descriptive analysis of variables, Kruskal-Wallis tests were used to determine statistically significant differences (p < 0.05) in response to the Delphi statements between professional groups. A hierarchical cluster analysis was undertaken to identify patterns of similarity/difference of response. A grounded theory approach to qualitative analysis of data allowed for potentially multiple iterations of the Delphi process to be influenced by identified themes. Of 55 expert panel members invited to participate, round 1 had 43 participants (Doctor n = 20, Paramedic n = 20, Nurse n = 5, other n = 2). No consistent patterns of opinion emerged with regards to professional group. Cluster analysis identified three patterns of similar responses and coded as trauma minimisers, the middle ground and the risk averse. Round 2 had 35 respondents with minimum change in opinion between rounds. Consensus of > 70% was achieved on many variables which included the identification of life/limb threatening injuries, deranged physiology, need for intensive care interventions and that extremes of age need special consideration. It was also acknowledged that retrospective injury severity scoring has a role to play but is not the only method of defining major trauma. Various factors had a majority of agreement/disagreement but did not meet the pre-set criteria of 70% agreement. These included the topics of burns, spinal immobilisation and whether a major trauma centre is the only place where major trauma can be managed. Based upon the output of this Delphi study, major trauma may be defined as: “Significant injury or injuries that have potential to be life-threatening or life-changing sustained from either high energy mechanisms or low energy mechanisms in those rendered vulnerable by extremes of age”.
Tài liệu tham khảo
Office for National Statistics. Deaths registered in England and Wales: 2018 2019 [Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregistrationsummarytables/2018#leading-causes-of-death.
Lecky F, Edwards A, Surendra Kumar D, White L, Coats TJ. Need for a UK injury control strategy. Emerg Med J. 2020;37(8):497. emermed-2020-209670.
Maddock A, Corfield AR, Donald MJ, Lyon RM, Sinclair N, Fitzpatrick D, et al. Prehospital critical care is associated with increased survival in adult trauma patients in Scotland. Emerg Med J. 2020;37(3):141–5. https://doi.org/10.1136/emermed-2019-208458.
Badiali S, Giugni A, Marcis L. Testing the START triage protocol: can it improve the ability of nonmedical personnel to better triage patients during disasters and mass casualties incidents ? Disaster Med Public Health Prep. 2017;11(3):305–9. https://doi.org/10.1017/dmp.2016.151.
Kahn CA, Schultz CH, Miller KT, Anderson CL. Does START triage work? an outcomes assessment after a disaster. Ann Emerg Med. 2009;54(3):424–30.e1.
Meena NN, Mehta D. Comparison of new injury severity score and revised trauma score in predicting outcome of trauma patients. J Clin Diagn Res. 2019;13(9):PC01–PC3.
Field V, Horne S, Smith J, Westran G, Kehoe A. The changing face of major trauma: significant changes in the demographics of major trauma in the south west of England over the last 20 years. Acad Emerg Med. 2012;19(6):737.
Butcher N, Balogh ZJ. The definition of polytrauma: the need for international consensus. Injury. 2009;40(Suppl 4):S12–22. https://doi.org/10.1016/j.injury.2009.10.032.
Butcher NE, Enninghorst N, Sisak K, Balogh ZJ. The definition of polytrauma: variable interrater versus intrarater agreement--a prospective international study among trauma surgeons. J Trauma Acute Care Surg. 2013;74(3):884–9. https://doi.org/10.1097/TA.0b013e31827e1bad.
Butcher NE, D'Este C, Balogh ZJ. The quest for a universal definition of polytrauma: a trauma registry-based validation study. J Trauma Acute Care Surg. 2014;77(4):620–3. https://doi.org/10.1097/TA.0000000000000404.
Butcher NE, Balogh ZJ. Update on the definition of polytrauma. Eur J Trauma Emerg Surg (Munich : 2007). 2014;40(2):107–11. https://doi.org/10.1007/s00068-014-0391-x.
Thompson L, Hill M, Shaw G. Defining major trauma: a literature review. Br Paramed J. 2019;4(1):22–30. https://doi.org/10.29045/14784726.2019.06.4.1.22.
Trauma Audit Research Network. The Injury Severity Score (ISS) 2020 [Available from: https://www.tarn.ac.uk/Content.aspx?ca=4&c=3117.
Alberdi F, Garcia I, Atutxa L, Zabarte M. Trauma and Neurointensive care work group of the SEMICYUC. Epidemiology of severe trauma. Med Int. 2014;38(9):580–8.
Scheibe M, Skutsch M, Schofer J, Linstone H, Turoff M. In: Linstone HA, Turoff, editors. The Delphi method: techniques and applications. Reading, MA: Addison-Wesley Publishing Company; 1975.
Paré G, Cameron A-F, Poba-Nzaou P, Templier M. A systematic assessment of rigor in information systems ranking-type Delphi studies. Inf Manag. 2013;50(5):207–17. https://doi.org/10.1016/j.im.2013.03.003.
Thompson L, Hill M, McMeekin P, Shaw G. Defining major trauma: a pre-hospital perspective using focus groups. Br Paramed J. 2019;4(3):16–23. https://doi.org/10.29045/14784726.2019.12.4.3.16.
Grant S, Booth M, Khodyakov D. Lack of preregistered analysis plans allows unacceptable data mining for and selective reporting of consensus in Delphi studies. J Clin Epidemiol. 2018;99:96–105. https://doi.org/10.1016/j.jclinepi.2018.03.007.
Mubarak N, Hatah E, MAM A, Shafie AA, Zin CS. Consensus among healthcare stakeholders on a collaborative medication therapy management model for chronic diseases in Malaysia. A delphi study. (research article)(report). PloS One. 2019;14(5):e0216563.
Chyung SY, Roberts K, Swanson I, Hankinson A. Evidence-based survey design: the use of a midpoint on the Likert scale. Perform Improv. 2017;56(10):15–23. https://doi.org/10.1002/pfi.21727.
Dolnicar S, Grün B. How constrained a response: a comparison of binary, ordinal and metric answer formats. J Retail Consum Serv. 2007;14(2):108–22. https://doi.org/10.1016/j.jretconser.2006.09.006.
Weinstein BD. What is an expert? Theor Med. 1993;14(1):57–73. https://doi.org/10.1007/BF00993988.
Bourne L, Kole J, Healy A. Expertise: defined, described, explained. Front in Psychol. 2014;5:186.
Keeney S, Hasson F, McKenna HP. A critical review of the Delphi technique as a research methodology for nursing. Int J Nurs Stud. 2001;38(2):195–200. https://doi.org/10.1016/S0020-7489(00)00044-4.
Sackman H. Delphi critique; expert opinion, forecasting, and group process: Lexington books; 1974.
Sinha IP, Smyth RL, Williamson PR. Using the Delphi technique to determine which outcomes to measure in clinical trials: recommendations for the future based on a systematic review of existing studies. PLoS Med. 2011;8(1):e1000393-e.
Kennedy-Shaffer L. Before p < 0.05 to beyond p < 0.05: using history to contextualize p-values and significance testing. Am Statistician. 2019;73(sup1):82–90.
Minitab. Data considerations for Kruskal-Wallis Test 2019 [Available from: https://support.minitab.com/en-us/minitab-express/1/help-and-how-to/modeling-statistics/anova/how-to/kruskal-wallis-test/before-you-start/data-considerations/.
Yim O, Ramdeen KT. Hierarchical cluster analysis: comparison of three linkage measures and application to psychological data. Quant Methods Psychol. 2015;11(1):8–21. https://doi.org/10.20982/tqmp.11.1.p008.
Sokal R, Sneath P. Principles of numerical taxonomy. San Francisco, CA: WH Freeman; 1963.
Saldaña J. The coding manual for qualitative researchers. Los Angeles: SAGE Publications; 2013.
Chapman AL, Hadfield M, Chapman CJ. Qualitative research in healthcare: an introduction to grounded theory using thematic analysis. J R Coll Physicians Edinb. 2015;45(3):201–5. https://doi.org/10.4997/JRCPE.2015.305.
Williams M. Interpretivism and generalisation. Sociology. 2000;34(2):209–24. https://doi.org/10.1177/S0038038500000146.
Abersek B. Elegance in science and science education. J Balt Sci Educ. 2015;14:420–3.
Magnone S, Ghirardi A, Ceresoli M, Ansaloni L. Trauma patients centralization for the mechanism of trauma: old questions without answers. Eur J Trauma Emerg Surg. 2017;45(3):421–36.
Potter D, Kehoe A, Smith JE. The sensitivity of pre-hospital and in-hospital tools for the identification of major trauma patients presenting to a major trauma Centre. J R Nav Med Serv. 2013;99(1):16–9. https://doi.org/10.1136/jrnms-99-16.
Stuke LE, Duchesne JC, Greiffenstein P, Mooney JL, Marr AB, Meade PC, et al. Not all mechanisms are created equal: a single-center experience with the national guidelines for field triage of injured patients. J Trauma Acute Care Surg. 2013;75(1):140–5. https://doi.org/10.1097/TA.0b013e3182988ae2.
Borger van der Burg BLS, Kessel B, DuBose JJ, Hörer TM, Hoencamp R. Consensus on resuscitative endovascular balloon occlusion of the aorta: a first consensus paper using a Delphi method. Injury. 2019;50(6):1186–91. https://doi.org/10.1016/j.injury.2019.04.024.
Dippenaar E, Wallis L. Pre-hospital intercostal chest drains in South Africa: a modified Delphi study. Afr J Emerg Med. 2019;9(2):91–5. https://doi.org/10.1016/j.afjem.2019.01.003.
Seymour-Walsh A. The development and critique of validated assessment tools for pre-hospital resuscitation skills. Int J Emerg Serv. 2019;8(1):50–63. https://doi.org/10.1108/IJES-03-2018-0018.