Defining the surgical critical care research agenda: Results of a gaps analysis from the Critical Care Committee of the American Association for the Surgery of Trauma.

Abstract

There has been an unprecedented increase in critical care research recently, and there is a need for an organized and systematic approach to surgical critical care research planning. The purpose of this article was to establish a surgical critical care research agenda via a systematic review of the literature and needs assessment. A systematic review of the literature was performed to identify high-impact critical care articles since 1999 on the basis of citation data. Using a standardized data abstraction tool, surgical representation in the literature was analyzed. A needs assessment was performed using a modified Delphi approach in three rounds to obtain consensus among members of the Critical Care Committee of the American Association for the Surgery of Trauma (n = 30) regarding research priorities in surgical critical care. Of 1,019 articles screened, 645 underwent full-text review, and 276 articles were included in the final analysis. Surgical patients were identified in 177 studies (64.1%), whereas trauma patients were identified in 82 (31.7%). Key categories identified during the first round of the Delphi included end of life care, traumatic brain injury (TBI), delirium, post-intensive care syndrome (PICS), hemodynamic monitoring, and volume/fluid balance. During the second and third rounds, 10 topics were classified as high priority. The three highest ranked topics were: addressing goals of care in the acute care setting (4.44 ± 0.70); improving prognostic indicators in patients with severe TBI (4.38 ± 0.85); and interventions to mitigate PICS (4.22 ± 0.65). There was a strong positive correlation in ratings (Rs value = 0.90, p = 0.001) between rounds 2 and 3. The results of this study highlight the recent surgical critical care research literature and may serve as a platform for future research endeavors in surgical critical care.