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NTRAP Aim 2: Core 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. [include the figure of the scoping review that highlights the main findings and key actions to take]

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 process. 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.

 

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, 29 met the consensus criteria as Core Outcomes:

  1. activities of daily living
  2. alcohol use
  3. anxiety
  4. behavior changes
  5. cognitive functioning (general)
  6. concentration/attention
  7. depressive symptoms
  8. disease-specific quality of life
  9. economic impact
  10. employment stability*
  11. executive functioning
  12. general physical health
  13. health-related quality of life
  14. healthcare utilization*
  15. instrumental activities of daily living
  16. mental health (general)
  17. pain (general)
  18. physical mobility
  19. post-concussion symptoms
  20. posttraumatic stress symptom spectrum
  21. prescribed narcotic use*
  22. relationship quality
  23. return to work*
  24. satisfaction with life
  25. sleep (general)
  26. social functioning (general)
  27. substance use
  28. suicidal ideation
  29. work status*

*Indicates that a domain did not have a measurement instrument indicated in the literature and therefore were not assessed in stage 2.

Stage 2

199 patient-reported outcome measures (PROMs) were identified in our scoping review to measure 24 of the core outcomes indicated in Stage 1. Of them, 14 unique measures reached consensus criteria within 13 core outcomes:

  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. Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference to measure pain (general), anxiety, mental health, depressive symptoms, and physical mobility
  8. Posttraumatic Stress Disorder Checklist (PCL-5) to measure PTSD
  9. Revised Trauma Quality of Life (RT-QoL) to measure activities of daily living
  10. Short Form Survey-12 (SF-12) to measure physical health (general)

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