Pre-hospital management of penetrating neck injuries: derivation of an algorithm through a National Modified Delphi

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2024年12月2日

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Christopher Simpson,
Harriet Tucker,
Joanne Griggs,
Maja Gavrilovski,
Richard Lyon,
Anthony Hudson,
John Breeze,
Michael Hughes,
Caroline Leech,
Adam Watts,
Matt Omeara,
Cosmo Scurr,
Alan Cowley,
Ewoud ter Avest,
Vicki Brown,
Malcolm Russell,
Ed Barnard,
Phil Cowburn,
Tom Hurst,
Andy Dunne,
Jim Walmsley,
Fionna Moore,
Will Charlton,
Simon Lewis,
Pam Hardy,
Tim Edwards,
James Yates,
Nigel Lang,
Gordon Ingram,
Steve Bell,
Clare Fitchett,
Andy Curran,
Matthew Boylan,
Emir Battaloglu,
Tim Nutbeam,
Matt Taylor,
Carl Smith,
Erica Ley,
Alex James

摘要

Background

Timely and effective pre-hospital management of penetrating neck injuries (PNI) is critical to improve patient outcomes. Pre-hospital interventions in patients with PNI can be especially challenging due to the anatomical injury site coupled with a resource-limited environment. Nationally, in the United Kingdom, no consensus statement or expert agreed guidance exists on how to best manage PNI in the pre-hospital setting.

Method

We conducted a national modified e-Delphi study with subject matter experts (SMEs) from multiple professional specialities with experience in the management of PNI. Pre-identified SMEs were contacted and consented prior to participation allowing for a remotely conducted Delphi using REDCap and Microsoft Teams. In Round 1, statements drawn from the literature base were distributed to all SMEs. Round 2 comprised a facilitated and structured discussion of the statements and then an online survey provided final ratification in Round 3. Of the participating SMEs consensus was set a priori at 70%.

Results

Of the 67 pre-identified SMEs, 28 participated, resulting in a response rate of 42%. From the first two rounds, 19 statements were derived with every statement achieving consensus in Round 3. Subsequently, an algorithm for the pre-hospital management of PNI was developed and agreed with SME consensus.

Conclusion

Curation of national consensus statements from SMEs aims to provide principles and guidance for PNI management in a complicated patient group where pre-hospital evidence is lacking. Multi-professional national consensus on the best approach to manage these injuries alongside a novel PNI management algorithm aims to optimise time critical care and by extension improve patient outcomes.