Research priorities for the management of complex fractures: a UK priority setting partnership with the James Lind Alliance

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Abstract

Objective

To determine research priorities for the management of complex fractures, which represent the shared priorities of patients, their families, carers and healthcare professionals.

Design/setting

A national (UK) research priority setting partnership.

Participants

People who have experienced a complex fracture, their carers and relatives, and relevant healthcare professionals and clinical academics involved in treating patients with complex fractures. The scope includes open fractures, fractures to joints broken into multiple pieces, multiple concomitant fractures and fractures involving the pelvis and acetabulum.

Methods

A multiphase priority setting exercise was conducted in partnership with the James Lind Alliance over 21 months (October 2019 to June 2021). A national survey asked respondents to submit their research uncertainties which were then combined into several indicative questions. The existing evidence was searched to ensure that the questions had not already been sufficiently answered. A second national survey asked respondents to prioritise the research questions. A final shortlist of 18 questions was taken to a stakeholder workshop, where a consensus was reached on the top 10 priorities.

Results

A total of 532 uncertainties, submitted by 158 respondents (including 33 patients/carers) were received during the initial survey. These were refined into 58 unique indicative questions, of which all 58 were judged to be true uncertainties after review of the existing evidence. 136 people (including 56 patients/carers) responded to the interim prioritisation survey and 18 questions were taken to a final consensus workshop between patients, carers and healthcare professionals. At the final workshop, a consensus was reached for the ranking of the top 10 questions.

Conclusions

The top 10 research priorities for complex fracture include questions regarding rehabilitation, complications, psychological support and return to life-roles. These shared priorities will now be used to guide funders and teams wishing to research complex fractures over the coming decade.

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Most cited references 12

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The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

Julian P. T. Higgins, Douglas G. Altman, Peter C. Gøtzsche … (2014)

Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate

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Changing the System - Major Trauma Patients and Their Outcomes in the NHS (England) 2008–17

Christopher G Moran, Fiona Elizabeth Lecky, Omar Bouamra … (2018)

Background Trauma care in England was re-organised in 2012 with ambulance bypass of local hospitals to newly designated Major Trauma Centres (MTCs). There is still controversy about the optimal way to organise health series for patients suffering severe injury. Methods A longitudinal series of annual cross-sectional studies of care process and outcomes from April 2008 to March 2017. Data was collected through the national clinical audit of major trauma care. The primary analysis was carried out on the 110,863 patients admitted to 35 hospitals that were ‘consistent submitters’ throughout the study period. The main outcome was longitudinal analysis of risk adjusted survival. Findings Major Trauma networks were associated with significant changes in (1) patient flow (with increased numbers treated in Major Trauma Centres), (2) treatment systems (more consultant led care and more rapid imaging), (3) patient factors (an increase in older trauma), and (4) clinical care (new massive transfusion policies and use of tranexamic acid). There were 10,247 (9.2%) deaths in the 110,863 patients with an ISS of 9 or more. There were no changes in unadjusted mortality. The analysis of trends in risk adjusted survival for study hospitals shows a 19% (95% CI 3%–36%) increase in the case mix adjusted odds of survival from severe injury over the 9-year study period. Interrupted time series analysis showed a significant positive change in the slope after the intervention time point of April 2012 (+ 0.08% excess survivors per quarter, p = 0.023), in other words an increase of 0.08 more survivors per 100 patients every quarter. Interpretation A whole system national change was associated with significant improvements in both the care process and outcomes of patients after severe injury. Funding This analysis was carried out independently and did not receive funding. The data collection for the national clinical audit was funded by subscriptions from participating hospitals.

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Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb

Matthew L Costa, Juul Achten, Julie Bruce … (2018)

Open fractures of the lower limb occur when a broken bone penetrates the skin. There can be major complications from these fractures, which can be life-changing.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2021

Publication date (Electronic): 30 November 2021

Volume: 11

Issue: 11

Electronic Location Identifier: e057198

Affiliations

[1 ] departmentNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford, UK

[2 ] James Lind Alliance , Southampton, UK

[3 ] Patient Representative , Wessex, UK

[4 ] Patient Representative , East Midlands, UK

[5 ] departmentClinical Psychology , Leeds General Infirmary , Leeds, UK

[6 ] departmentPhysiotherapy , University Hospitals Coventry and Warwickshire NHS Trust , Coventry, UK

[7 ] departmentWarwick Clinical Trials Unit , University of Warwick , Coventry, UK

[8 ] departmentOrthogeriatrics , University Hospital Southampton NHS Foundation Trust , Southampton, UK

[9 ] departmentTrauma & Orthopaedic Surgery , James Cook University Hospital , Middlesbrough, UK

[10 ] departmentPlastic Surgery , Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield, UK

[11 ] departmentTrauma & Orthopaedic Surgery , Queen Mary University of London , London, UK

Author notes

[Correspondence to ] Christopher Patrick Bretherton; christopher.bretherton@ 123456ndorms.ox.ac.uk

Author information

Christopher Patrick Bretherton http://orcid.org/0000-0001-9569-0734

Rebecca Samantha Kearney http://orcid.org/0000-0002-8010-164X

Xavier Luke Griffin http://orcid.org/0000-0003-2976-7523

Article

Publisher ID: bmjopen-2021-057198

DOI: 10.1136/bmjopen-2021-057198

PMC ID: 8634374

PubMed ID: 34848529

SO-VID: af8acb9d-e5e2-435d-9295-589a074ed339

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 07 September 2021

Date accepted : 08 November 2021

Funding

Funded by: AOUK&Ireland;

Award ID: HFR03160

Custom metadata

special-feature unlocked

ScienceOpen disciplines: Medicine

Keywords: complex fractures,trauma,priority setting

Data availability:

ScienceOpen disciplines: Medicine

Keywords: complex fractures, trauma, priority setting

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Research priorities for the management of complex fractures: a UK priority setting partnership with the James Lind Alliance

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Abstract

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Design/setting

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Conclusions

Related collections

Orthopedics

Most cited references 12

The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

Changing the System - Major Trauma Patients and Their Outcomes in the NHS (England) 2008–17

Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb

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Cited by 4

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