Major Trauma PSP Question Verification Form

  • Published: 18 November 2022
  • Version: V1
  • 4 min read

The purpose of this Question Verification Form is to enable Priority Setting Partnerships (PSPs) to describe clearly how they checked that their questions were unanswered, before starting the interim prioritisation stage of the process.

The JLA requires PSPs to be transparent and accountable in defining their own scope and evidence checking process. This will enable researchers and other stakeholders to understand how individual PSPs decided that their questions were unanswered, and any limitations of their evidence checking.

Name of the PSP

Major Trauma

Please describe the scope of the PSP

The PSP aim is to identify the unanswered questions about Major Trauma from the patient, carer, and clinical perspectives.

The PSP definition of Major Trauma will mirror the scope of the NICE guidelines for major trauma: https://www.nice.org.uk/guidance/ng39 and https://www.nice.org.uk/guidance/ng40 in adults.

This will include:

  • Chest injury
  • Abdominal injury
  • Pelvic fractures
  • Major Bleeding
  • Life or Limb-threatening injuries
  • Multiple traumatic injuries

The PSP scope will include the following aspects of care for patients of all ages and geography:

  • Prehospital care (immediately after injury to arrival at hospital)
  • Immediate hospital care after injury (reception and resuscitation)
  • Transfer between acute hospitals (trauma unit to major trauma centre)
  • In-patient care until discharge from an acute hospital

The PSP excludes from its scope questions about:

  • Isolated spinal cord injury
  • Isolated head injury
  • Injury prevention and public health interventions
  • Post-hospital care and interventions
  • Post-traumatic stress disorder
  • Burns
  • Treatment unique to military or resource-limited settings
  • Hanging, asphyxia and drownings
  • Safeguarding

Please provide a brief overview of your approach to checking whether the questions were unanswered

Questions submitted by patients and clinicians to the survey were collated and categorised into indicative questions. These preliminary questions were agreed on by the Steering Group. The verification process aimed to determine which of these questions are unanswered by research to date.

Our search strategy was stepwise starting with the most reliable sources and working down. This enabled answered questions to be identified efficiently.

The following process was followed for each question:

  1. Guidelines (NICE, SIGN, Royal College, or Professional association) were reviewed to determine whether they covered that question. If they did, then evidence behind the guidelines was reviewed. Where this evidence was low-quality, e.g., observational research or expert consensus, this was discussed with the steering group to determine whether to consider the question answered or unanswered.

  2. Cochrane reviews were searched using keywords specific to each question. Where a review called for further research, the question was not considered answered. If the systematic review was older than 6 years old, recent RCTs were also searched to ensure the question had not been answered more recently.

  3. Database searches on OVID and Google Scholar were conducted using keywords specific to each question. Randomised controlled trials (RCTs) were reviewed and if no strong conclusion could be drawn from the study, the question was considered unanswered. The level of evidence of each RCT was reviewed.

  4. Ongoing and future trials were reviewed on registries. These were used to identify questions that may be answered in the coming years. The aim was not to exclude questions at this stage but to take these into account to help prioritise the 25 questions that were taken to the final workshop.

Please list the type(s) of evidence you used to verify your questions as unanswered

  • National Guidelines (NICE, SIGN, Royal College, or Professional association)
  • Systematic Reviews (including Cochrane)
  • If systematic reviews were older than 5 years, recent RCTs were reviewed
  • If no systematic reviews available, any RCTs were reviewed
  • Ongoing and future trials were logged

Please list the sources that you searched to identify that evidence

Systematic review or RCT evidence found via:

  • Cochrane Central Register of Controlled Trials (https://www.cochranelibrary.org)
  • OVID (databases included Pubmed, CINAHL, AMED, BNI, EMBASE, HBE, Medline, and PschINFO);
  • Google Scholar (https://scholar.google.co.uk);
  • the WHO International Clinical Trials Registry Platform Search Portal (http://www.who.int/ictrp/en),
  • Current Controlled trials (http://www.isrctn.com),
  • the US National Institute of Health Trials Registry (https://clinicaltrials.gov)
  • Published UK national guidelines – NICE, SIGN, BOA, BAPRAS

What search terms did you use?

Keywords of each question were used in each database and tailored to each question.
Examples of keywords were:

  • Major Trauma
  • Rehabilitation
  • Limb salvage
  • Communication

Please describe the parameters of the search (e.g., time limits, excluded sources, country/language) and the rationale for any limitations

  • All guidelines were in English. All studies were included however, recent evidence in the last years was seen to be stronger than older evidence.
  • The search was limited to English only for clinical guidelines.
    No language limitation for systematic reviews or studies.

Names of individuals who undertook the evidence checking

  • Hamez Gacaferi
  • Robert Hirst
  • Uncertainties were discussed with the Steering Group.

On what date was the question verification process completed?

  • 09-11-2022

Any other relevant information

  • A consultant surgeon (XG) confirmed no significant papers were missed which could provide answers to the shortlisted questions.