Cynthia Lizette Villarreal

Introduction: To support the development of the National Trauma Research Repository (NTRR), a multidisciplinary workgroup focused on prehospital trauma care used a consensus-driven approach to review established data elements and recommend basic common data elements (CDEs) for inclusion in the NTRR data dictionary. Methods: A 13-member workgroup of military and civilian trauma researchers and data scientists located and reviewed databases, codebooks, data collection forms, and published articles for data elements relevant to prehospital trauma care. Identified data elements were reviewed in a three-round Delphi survey and during monthly workgroup meetings. Consensus during the Delphi survey was determined with an 80% agreement threshold. Results: Twenty-one sources were reviewed for prehospital data elements. Following three rounds and workgroup discussions, 52 elements (84%) reached consensus for inclusion, two elements (3%) were excluded, and eight elements (13%) did not reach consensus. Discussion: The Delphi process proved effective in achieving expert consensus on basic CDEs for prehospital trauma care research. The resulting standardized basic CDEs will improve data harmonization and support consistent data collection in the NTRR. These CDEs represent an initial framework and serve as a foundational starting point for prehospital data collection within the NTRR. As researchers use the NTRR, the list of CDEs will grow and evolve to meet the needs of the trauma research community.

The second Design for Implementation (DFI): The Future of Trauma Research and Clinical Guidance Conference gathered experts from diverse sectors to advance trauma clinical guidance design and implementation. Building on the previous year’s minimum viable product, this conference progressed from conceptualization to design phase, focusing on creating scalable, sustainable solutions for trauma clinical guidance. Participants explored innovative approaches addressing critical challenges in trauma care, including interorganizational collaboration, resource-adaptable guidance, and patient-centered design. The conference highlighted the integration of artificial intelligence (AI) to enhance guidance development and maintain clinical expertise and ethical standards. A key advancement was the refinement of a central repository containing 258 guidance documents in the form of an app with improved accessibility features. Discussions emphasized the importance of implementation science principles, advocating for leadership engagement, maintaining academic recognition for guidance contributions, and continuous outcome tracking. The proposed 12-step guidance development process integrates AI capabilities and preserving clinician expertise. Patient voices and lived experiences were emphasized as essential elements in developing trauma-informed systems, with powerful testimonials from trauma survivors illustrating the critical need for comprehensive support services. Participants agreed that practical guidance must be contextually relevant, properly vetted, and integrate seamlessly with electronic health records. The conference concluded with plans to secure sustainable funding, formalize partnerships, and engage broader communities. The DFI series will continue in February 2026, focusing on testing and implementing innovative solutions to advance trauma care and improve patient outcomes.

With joint collaboration and support from the Coalition for National Trauma Research and the Agency for Healthcare Research and Quality, the second meeting of the 3-year conference series Design for Implementation: The Future of Trauma Research and Clinical Guidance (DFI) Conference Series occurred at the American College of Surgeons on February 19–20, 2025. The first year of the conference built consensus and shared understanding of the barriers preventing the development and dissemination of timely, relevant, and accessible trauma clinical guidance. Focus in this second year sought to build on the prior year’s work, emphasizing a patient-centered approach to the codesign of solutions to overcome these barriers.

Traumatic injury is the leading cause of death for individuals aged 1–45 in the USA. Variations in patient management based on geographic locations, community resources, and provider characteristics contribute to disparities in patient outcomes. It is estimated that 20,000 Americans lives could be saved yearly if all trauma centers performed as well as the highest-performing center, which is achievable, in part, through the reduction of inappropriate practice variation. Trauma clinical guidance currently lacks standardization, is redundant, and remains difficult to access and implement at the bedside. To explore and address these issues, the Design for Implementation: The Future of Trauma Research and Clinical Guidance (DFI) Conference Series was developed. This conference series and complementary research aims to redesign the development, dissemination, and implementation of trauma clinical guidance with a focus on more effective and equitable systems. To do so, key community partners were convened to present clinical guidance best practices, including digital integration, resource stratification, and patient-centeredness. Conference attendees, which included partners from various provider groups, patients, dissemination and implementation scientists, public health experts, government agencies, and software developers, worked together to create a “minimum viable product” which specified key objectives for an ideal future state of trauma clinical guidance, as well as the “risk”, “audience”, and “key performance indicators”. The next conference in the series will take place in February 2025, with a focus on translating the conceptualized priorities into tangible solutions. This paper serves to share the events from the 2024 conference proceedings.

The first meeting of the Design for Implementation: The Future of Trauma Research and Clinical Guidance (DFI) Conference Series occurred at the American College of Surgeons (ACS) in Chicago, Illinois, on February 21–22, 2024. This 3-year conference series aims to improve the development and dissemination of trauma clinical guidance nationally and beyond. Conducted in collaboration with the Coalition for National Trauma Research (CNTR) and supported in part by the Agency for Healthcare Research and Quality (AHRQ), a diverse group of multidisciplinary partners gathered to begin collaboratively redesigning the national approach to trauma clinical guidance development and dissemination with a focus on improved equity and effectiveness. The endeavor was marked by an emphasis on the patient voice and featured 36 presenters ranging from trauma surgeons and public health experts to software developers and others with unique expertise to develop innovative solutions. The collective aim of the attendees is clear: better care for patients, less burnout for providers, and a future where trauma clinical guidance is collaboratively developed and designed for implementation (figure 1).

In the USA, traumatic injury results in a significant financial burden, which is unevenly distributed in our society. In this paper, we will highlight some of the data around the costs of injury associated with a focus on socially vulnerable and historically resilient groups at risk for disparate outcomes. We delve into the concept of economic return on investment from multiple perspectives: the patient perspective, the community perspective and from a national and policy perspective. Targeted policy changes and dedicated efforts towards minimizing gaps in trauma care and enhancing survivorship can yield substantial economic benefits. This paper also describes several national funding agencies and their current priorities related to funding in equity and trauma research. This manuscript will demonstrate that reducing disparities in trauma care not only serves a moral imperative but also a necessary and financially sound strategy with a good economic return on investment.

Despite remarkable advances in clinical care, injury remains a leading cause of death in the USA. Recent studies in the care of the injured patient have begun to unearth the crucial influence of health disparities and health inequity on outcomes after injury. Importantly, it is known that there are strikingly disparate outcomes following injury based on demographic backgrounds, with racial and ethnic minoritized groups having a higher risk of death from traumatic injury. This paper highlights the problem of health inequity after injury by addressing health and health care disparities in trauma with a focus on the proceedings from the Summit on the Advancement of Focused Equity Research in Trauma organized by Coalition for National Trauma Research’s Equity, Diversity and Inclusion Committee. Included in this work is an assessment of the structural determinants of health inequities and the evidence for widespread inequities across the continuum of trauma care; with an emphasis on five vital, actionable steps towards health equity that can be taken now by the trauma community, including firearm injury prevention, Medicaid expansion, trauma-informed care, equity measurement and benchmarking, and improving trauma survivorship. Ultimately, to move towards improved quality of care for all injured patients, we must eliminate health care disparities in trauma care across the continuum and work towards more equitable care for all.

On August 2–3, 2023, the Summit on the Advancement of Focused Equity Research in Trauma (SAFER-Trauma) was convened at the American College of Surgeons headquarters in Chicago, Illinois. The summit convened key stakeholders to overview health inequities in trauma, highlight relevant current research, and address the following aims: (1) characterize current gaps regarding health equity research in trauma, (2) identify research funding mechanisms and pathways for collaboration, and (3) outline a research agenda to address inequities in trauma. Participants in SAFER-Trauma took stock of existing disparities in injury care and research and considered innovative solutions to address them. SAFER-Trauma was designed by the Coalition for National Trauma Research’s (CNTR) Equity, Diversity and Inclusion Committee (EDIC), chaired by Vanessa Ho, MD, PhD, MPH, FACS. The first day of the conference focused on the Current State of Trauma Research and Disparities, and the second day focused on A Unified Response to Address Disparities in Trauma Research.

Trauma research is an expansive discipline that informs injury prevention, best practices in care, and novel interventions. However, implicit bias, or the unconscious stereotypical beliefs about groups of people, can have profound implications for traumatic injury research. Several forms of implicit bias can emerge in trauma research, which deepens existing disparities based on race or ethnicity, sex, ability status, socioeconomic status, and other factors. This paper reviews how implicit bias affects the development of research and the application of findings, potentially leading to suboptimal care and misdirected preventive strategies in trauma. We present the recent dialogue and progress on implicit bias in research at the Summit on the Advancement of Focused Equity Research in Trauma (SAFER-Trauma) conference, an Agency for Healthcare Research and Quality-funded assembly of multiple disciplines which was convened to tackle the challenges involved in addressing disparities in traumatic injury. Through this review, we seek to generate momentum for action toward reducing implicit bias and establishing comprehensive equity-focused standards of trauma research and practice.

On August 2–3, 2023, the Summit on the Advancement of Focused Equity Research in Trauma (SAFER-Trauma) convened to discuss strategies to support research to eliminate disparities in trauma care. An ongoing challenge for performing high-quality equity-based research is the uncomfortable recognition that implicit bias and structural racism are deeply ingrained in our society and culture and are therefore often unrecognized in medicine and research practices. Throughout SAFER-Trauma, several examples of strategies to overcome these challenges were presented. In this article, we will relate a diverse array of examples through three distinct angles. The first focuses on innovations that harness existing data in novel and groundbreaking ways, uncovering fresh insights and applications from information already at our disposal. The second examines innovations that arise from traditional healthcare systems and research methods, showing how research in the healthcare sphere can adapt to meet modern needs. The third will explore projects that emerged from communities, driven by the pressing needs and aspirations of the people they serve.