O0804 Oct.3: 1:47pm - Research Priorities in Pediatric Orthopaedic Trauma as Determined by the IMPACCT Consensus Conference

Purpose: Randomized controlled trials (RCTs) are considered the most rigorous type of clinical research. Pediatric orthopaedic surgery has historically lacked the infrastructure and administrative support to conduct high-quality multicenter studies. The IMPACCT (Infrastructure for Musculoskeletal Pediatric Acute Care Clinical Trials) consortium was formed as a resource to support the adoption of RCTs through a multicenter model to address questions in pediatric orthopedic surgery. The IMPACCT Consensus Conference was organized to determine which topics to prioritize for RCTs and obtain the buy-in of surgeons for future multicenter RCTs on these topics. The purpose of this study was to determine the priority RCTs as a result of the Consensus Conference.

Methods: We solicited members of POSNA for possible questions that could be studied. The IMPACCT Organizing Committee chose six questions to be presented, debated, and ranked at the Consensus Conference for prioritization to complete multicenter RCTs. Representatives from 32 centers across the US and Canada representing 288 surgeons were invited to participate in the process. During the Consensus Conference surgeons discussed protocols, refined methodologies, and prioritized outcomes. Surveys were administered before, during, and after the meeting. Topics were scored from 1-5 (5=highest) based on significance, protocol, willingness to randomize, outcomes, and overall likelihood of a center to participate. Topics were then ranked in order of priority. Descriptive statistics and a mixed model ANOVA were used to ascertain the order of priorities and changes in ratings for each topic.

Results: Mean rankings during the meeting for each research topic were as follows – 1.3 for medial epicondyle fractures, 2.4 for distal radius fractures, 4.0 for distal tibia fractures, 4.3 for tibial spine fractures, 4.5 for femur fracture, and 4.5 for lateral condyle fractures. See table for frequency distribution by topic. Ratings for the overall likelihood of participating for the distal radius fracture topic significantly increased from a score of 3.3 pre-meeting to 4.2 immediately after discussion (p=0.002). Ratings did not significantly change for the five other topics. The range of ratings for medial epicondyle fractures decreased from 3 in pre-meeting to 2 in both intra-meeting and post-meeting.

Conclusions: This consensus conference format allowed representatives to prioritize and critically examine the various components of selected research questions. The ability to share opinions across a diverse group of surgeons and institutions influenced representatives’ overall willingness to conduct research on certain topics. During the conference, topics were reevaluated and an order of priorities emerged. After the meeting, a convergence of opinion remained for one topic – medial epicondyle fractures, indicating that the surgeons were able to reach consensus on the priority of this research question. Consequently, our group is prioritizing the treatment of medial epicondyle fractures as the main focus of a future RCT.