TY - JOUR
T1 - Development of a set of patient-centred outcome measures for patients with major injury
T2 - Delphi-based consensus recommendations from the International Consortium for Health Outcomes Measurement Major Injury Working Group
AU - van der Wal, Henk
AU - Collot d'Escury, Winny
AU - de Silva, Umanga
AU - Saoud, Yasmine
AU - Jennings, Grace
AU - Aitken, Leanne M
AU - Carey, Katelyn
AU - Chowdhury, Sharfuddin
AU - Civil, Ian
AU - Clarke, Damian
AU - Cudmore, Tim
AU - Diaz, Candi
AU - Herrera-Escobar, Juan P
AU - Hoencamp, Rigo
AU - Hoffman, Karen
AU - Lang, Kelly
AU - Martin, Katherine
AU - Marvel, Debra
AU - Mathew, Joseph
AU - McGilloway, Emer
AU - Nijs, Stefaan
AU - Silva Paiva, Wellingson
AU - Quick, Kat
AU - Ribeiro, Marcelo A F
AU - Richmond, Therese S
AU - Sandersjöö, Gunnar
AU - Sawaguchi, Takeshi
AU - Schreiber, Martin
AU - Schuetz, Michael
AU - Thompson, Hilaire
AU - van Dongen, Thijs
AU - van Lutterveld, Remko
AU - Zhang, Guixi
AU - Gabbe, Belinda
N1 - Publisher Copyright:
The Author(s)
PY - 2025/12
Y1 - 2025/12
N2 - BACKGROUND: Major injury contributes substantially to global morbidity and mortality, yet outcome measurement remains inconsistent. Development of a standardised set of patient-centred outcome measures for adults with major injuries has the potential to improve global benchmarking, quality of care and patient-centre value-based healthcare.METHODS: An international multidisciplinary working group of 28 experts and patient representatives from 11 countries (3 middle- and 8 high income) was convened. Following International Consortium for Health Outcomes Measurement methodology, a structured consensus-driven process was used, which included literature reviews, three modified Delphi rounds, and validation surveys. The target population included adult patients receiving acute care for physical injuries with an Injury Severity Score ≥9. Literature searches (Apr 16, 2005-Jun 1, 2024) in PubMed, MEDLINE, Embase.com, PsychINFO, CINAHL, and ProQuest identified relevant outcomes, measures, case-mix variables, and follow-up timepoints. Consensus on inclusion required ≥80% of members rating outcomes 7-9 on a 9-point scale. The Delphi process ran from Jul 3 to Nov 13, 2024, with patient and professional validation surveys respectively conducted between Dec 5, 2024 and Mar 28, 2025 and between Mar 5, and 28, 2025.FINDINGS: Seventy-two percent (n = 20) of members participated in eight calls, and 68% (n = 19) in nine surveys. The final set includes 26 outcomes (22 patient-reported, 4 clinician-reported) across four domains: patient-reported health status, functioning, psychological wellbeing and mental health, and clinical outcomes. Six patient-reported outcome measures and four injury-specific tools were endorsed. Thirty case-mix variables were identified, with measurement at baseline (as soon as possible after the injury, conditional upon the clinical stability of and safety for the patient), 6 months, and 12 months. Validation surveys with patients (n = 121) and professionals (n = 70) confirmed relevance and comprehensiveness, with >83% (n = 159) agreement on core domains. A primary subset of essential outcome measures was defined to facilitate implementation.INTERPRETATION: To our knowledge, this is the first international consensus-derived outcome set for major injury, supporting benchmarking of care, of outcomes of importance to patients and clinicians. We acknowledge the lack of representation from low-resource countries or regions in the working group and patient survey. Further implementation and feasibility testing are needed to ensure applicability across diverse populations, health systems and settings (e.g. military). In particular, validation in low- and middle-income settings is needed to ensure equity, feasibility and cultural relevance.FUNDING: Transport Accident Commission, Stichting ZiektekostenVerzekering Krijgsmacht, AO Foundation.
AB - BACKGROUND: Major injury contributes substantially to global morbidity and mortality, yet outcome measurement remains inconsistent. Development of a standardised set of patient-centred outcome measures for adults with major injuries has the potential to improve global benchmarking, quality of care and patient-centre value-based healthcare.METHODS: An international multidisciplinary working group of 28 experts and patient representatives from 11 countries (3 middle- and 8 high income) was convened. Following International Consortium for Health Outcomes Measurement methodology, a structured consensus-driven process was used, which included literature reviews, three modified Delphi rounds, and validation surveys. The target population included adult patients receiving acute care for physical injuries with an Injury Severity Score ≥9. Literature searches (Apr 16, 2005-Jun 1, 2024) in PubMed, MEDLINE, Embase.com, PsychINFO, CINAHL, and ProQuest identified relevant outcomes, measures, case-mix variables, and follow-up timepoints. Consensus on inclusion required ≥80% of members rating outcomes 7-9 on a 9-point scale. The Delphi process ran from Jul 3 to Nov 13, 2024, with patient and professional validation surveys respectively conducted between Dec 5, 2024 and Mar 28, 2025 and between Mar 5, and 28, 2025.FINDINGS: Seventy-two percent (n = 20) of members participated in eight calls, and 68% (n = 19) in nine surveys. The final set includes 26 outcomes (22 patient-reported, 4 clinician-reported) across four domains: patient-reported health status, functioning, psychological wellbeing and mental health, and clinical outcomes. Six patient-reported outcome measures and four injury-specific tools were endorsed. Thirty case-mix variables were identified, with measurement at baseline (as soon as possible after the injury, conditional upon the clinical stability of and safety for the patient), 6 months, and 12 months. Validation surveys with patients (n = 121) and professionals (n = 70) confirmed relevance and comprehensiveness, with >83% (n = 159) agreement on core domains. A primary subset of essential outcome measures was defined to facilitate implementation.INTERPRETATION: To our knowledge, this is the first international consensus-derived outcome set for major injury, supporting benchmarking of care, of outcomes of importance to patients and clinicians. We acknowledge the lack of representation from low-resource countries or regions in the working group and patient survey. Further implementation and feasibility testing are needed to ensure applicability across diverse populations, health systems and settings (e.g. military). In particular, validation in low- and middle-income settings is needed to ensure equity, feasibility and cultural relevance.FUNDING: Transport Accident Commission, Stichting ZiektekostenVerzekering Krijgsmacht, AO Foundation.
U2 - 10.1016/j.eclinm.2025.103617
DO - 10.1016/j.eclinm.2025.103617
M3 - Article
C2 - 41497505
SN - 2589-5370
VL - 90
JO - EClinicalMedicine
JF - EClinicalMedicine
M1 - 103617
ER -