Developing a National Trauma Research Action Plan (NTRAP): Results from the Regulatory Challenges Delphi Survey

Abstract

ABSTRACT Background In 2016, the National Academies of Sciences, Engineering, and Medicine (NASEM) issued a report calling for a National Trauma Research Action Plan requiring a resourced, coordinated, joint approach to trauma care research. The NASEM report recommended the identification of regulatory barriers to trauma research. The NTRAP Regulatory Challenges Panel of trauma researchers and regulatory professionals was convened to identify the most challenging aspects of regulatory processes involved in conducting research. Methods Trauma researchers and regulatory experts were recruited to identify and rate challenging regulatory issues in 2021-2022. Challenge statements were developed from a comprehensive scoping review. Panelists rated the challenge level for each statement on a 9-point Likert scale. The Delphi survey was conducted over 3 online rounds. Consensus was defined a priori as ≥60% agreement. Results of the Delphi survey were presented to the panel during a webinar. Panel participants then participated in breakout sessions to strategize solutions, share lessons learned and identify where more regulatory guidance is needed. Results Thirty-eight subject matter experts rated 175 regulatory challenges, of which 141 reached the consensus threshold (81%). Of the consensus-reaching challenge statements, 42 had a challenge rating of 6 or higher. Among the highest-rated challenges were issues pertaining to conducting pre-hospital research, Exception From Informed Consent, mistrust of research among various racial and ethnic groups, and issues specific to conducting pediatric trauma research. Conclusions This Delphi survey rated challenges culled from a regulatory literature scoping review. The panel identified the most challenging aspects of human subjects protection while conducting trauma research and recommended strategies and best practices to address them. The findings from this study were used to develop the NTRAP Investigator Toolkit which is available on the internet as a resource for trauma researchers. Level of Evidence Expert consensus Type of Study Original research/Expert consensus