J Trauma Acute Care Surg. 2019 Jan 10; Epub ahead of print

# The "top 10" Research and Development Priorities for Battlefield Surgical Care: Results From the Committee on Surgical Combat Casualty Care Research gap Analysis.

Martin M, Holcomb J, Polk T, Hannon M, Eastridge B, Malik S, Blackman V, Galante J, Grabo D, Schreiber M, Gurney J, Butler F, Shackelford S.

BACKGROUND: The US Military has achieved the highest casualty survival rates in its history. However, there remain multiple areas in combat trauma that present challenges to the delivery of high quality and effective trauma care. Previous work has identified research priorities for pre-hospital care, but there has been no similar analysis for forward surgical care.

METHODS: A list of critical "focus areas" was developed by the Committee on Surgical Combat Casualty Care (CoSCCC). Individual topics were solicited and mapped to appropriate focus areas by group consensus and review of EAST and JTS guidelines. A web-based survey was distributed to the CoSCCC and the military committees of EAST and AAST. Topics were rated on a Likert scale from 1 (low) to 10 (high priority). Descriptives, univariate statistics, and inter-rater correlation analysis was performed.

RESULTS: 13 research focus areas were identified (8 clinical and 5 adjunctive categories). Ninety individual topics were solicited. The survey received 64 responses. The majority of respondents were military (90%) versus civilians (10%). There was moderate to high agreement (inter-rater correlation coefficient=0.93, p<0.01) for 10 focus areas. The top 5 focus areas were Personnel/Staffing (mean=8.03), Resuscitation & Hemorrhage Management (7.49), Pain/Sedation/Anxiety Management (6.96), Operative Interventions (6.9), and Initial Evaluation (6.9). The "Top 10" research priorities included 4 in Personnel/Staffing, 4 in Resuscitation/Hemorrhage Management, and 3 in Operative Interventions. A complete list of the topics/scores will be presented.

CONCLUSIONS: This is the first objective ranking of research priorities for combat trauma care. The "Top 10" priorities were all from 3 focus areas, supporting prioritization of personnel/staffing of austere teams, resuscitation/hemorrhage control, and damage control interventions. This data will help guide DOD research programs and new areas for prioritized funding of both military and civilian researchers.