NTRAP Aim 2: Determining the Core [Patient-Reported] Outcome Set (COS)
In 2019, the American College of Surgeons Committee on Trauma and the Childress Institute for Pediatric Trauma held consensus conference on patient-reported outcome measures (PROMs). This conference discussed, in part, identifying instruments to collect long-term outcomes after injury. These discussions helped inform the design of a scoping review of literature on available PROMs to assess long-term outcomes after acute physical injury.
We then presented the results of this scoping review to a panel of experts (clinicians, researchers, patients) and conducted a two-pronged modified Delphi consensus survey. Our first two rounds were used to identify a set of core domains to evaluate long-term outcomes. After these domains had been determined, we conducted three more rounds to determine PROMs for said domains, arriving at a final set of Core Outcome Measures.

Figure 1. Overall Process to Develop a Core Outcome Set and a Core Outcome Measurement Set for Research in Traumatic Injury Survivors
Stage 1
Out of 74 core outcomes identified in the NTRAP Aim 2 scoping review and reviewed by our Delphi panel, 29 met the consensus criteria and were determined to be important. Thus, our Core Outcome Set (COS) to be considered in Stage 2 was:
- Activities of daily living
- Alcohol use
- Anxiety
- Behavior changes
- Cognitive functioning (general)
- Concentration/attention
- Depressive symptoms
- Disease-specific quality of life
- Economic impact
- Employment stability*
- Executive functioning
- General physical health
- Health-related quality of life
- Healthcare utilization*
- Instrumental activities of daily living
- Mental health (general)
- Pain (general)
- Physical mobility
- Post-concussion symptoms
- Post-traumatic stress symptom spectrum
- Prescribed narcotic use*
- Relationship quality
- Return to work*
- Satisfaction with life
- Sleep (general)
- Social functioning (general)
- Substance use
- Suicidal ideation
- Work status*
*Indicates that a domain did not have a measurement instrument indicated in the literature and therefore was not assessed in stage 2.
Stage 2
For the 24 core patient-reported outcomes that reached consensus as important in Stage 1, our scoping review identified 199 measures being administered for them (patient-reported outcome measures, or PROMs). Following Stage 2, 14 unique measures reached our consensus criteria within 13 of those core outcomes. Thus, the Core Outcome Measurement Set (COMS) is:
1 – Alcohol Use Disorders Identification Test (AUDIT-C) to measure alcohol use
2 – CAGE Questionnaire to measure substance abuse disorders
3 – General Anxiety Disorder-7 to measure anxiety
4 – Glasgow Outcome Scale – Extended (GOS-E) to measure cognitive functioning
5 – Patient Health Questionnaire-8 (PHQ-8) to measure depressive symptoms
6 – Patient Health Questionnaire-9 (PHQ-9) to measure depressive symptoms
7-11 – Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference to measure pain (general), anxiety, mental health, depressive symptoms, and physical mobility
12 – Post-traumatic Stress Disorder Checklist (PCL-5) to measure PTSD
13 – Revised Trauma Quality of Life (RT-QoL) to measure activities of daily living
14 – Short Form Survey-12 (SF-12) to measure physical health (general)