A global Core Outcome Set to optimise the evidence base for burn care (COSB-i).

Abstract

Gold-standard medical care requires collated evidence from systematic reviews, to support clinicians in identifying the treatment that results in optimal patient outcomes. In burn care, this evidence is required to improve survival, optimise function and cosmesis, and minimise the pain and psychological impact of the injury. Although burns are common (11 million annual global incidence), management and outcomes vary within and between countries. This is likely to be due to a lack of guidelines based on synthesised evidence. One reason that data from trials cannot be synthesised, is because of a variation in outcome reporting across trials. Establishing how to improve this is challenging. The development of a Core Outcome Set (COS), a scientifically agreed minimum set of the most important outcomes to be reported in all studies of a medical condition, is likely to provide the answer.

The aim of this thesis is to explore variation in outcome reporting in burn care research and to develop a COS as a novel solution to this problem.

Four systematic reviews and a mixed-methods study, including Delphi surveys and a consensus meeting were undertaken. The reviews highlighted the extent of outcome heterogeneity across burn trials, problems with outcome definition and timing of assessment and a focus on short-term clinical, not patient-important, outcomes.

Development of the COS has used shared decision-making, with 668 health professionals from 77 countries of varying income, and 126 UK patients, ensuring relevance to both stakeholder groups. Seven core outcomes have been agreed: death, specified complications, ability to do daily tasks, wound healing, neuropathic pain and itch, patient psychology and time to return to school or previous occupation.

It is hoped that this COS will improve data synthesis, to support evidence-based clinical decision-making. This will ultimately resolve uncertainty over clinical decisions to ensure optimal care for burn patients globally.

Date of Award	29 Sept 2020
Original language	English
Awarding Institution	University of Bristol National Institutes of Health
Supervisor	Jane Blazeby (Supervisor), Chris Metcalfe (Supervisor) & Sara Brookes (Supervisor)