Core outcome set for liver trauma: a consensus approach using modified Delphi methodology

Objectives: Liver trauma management has evolved over recent decades, shifting from primarily operative to algorithmic approaches incorporating initial non-operative management alongside operative intervention for severe injuries. Inconsistent core outcome measures between studies hamper meaningful clinical research and evidence synthesis. This study aimed to develop a core outcome set (COS) for liver trauma research to standardize outcome reporting and improve study comparability. Methods: A modified Delphi consensus methodology after COMET (Core Outcome Measures in Effectiveness Trials) and COS-STAD (Core Outcome Set-Standards for Development) guidelines was employed and twenty trauma surgery experts were recruited through purposive sampling of high-impact publications and professional networks. Round 1 collected free-text outcome suggestions. Round 2 used a 9-point Likert scale rating of those previously identified outcomes. Consensus was defined as ≥70% rating outcomes as critically important (7-9) and ≤15% as unimportant (1-3). Intraclass correlation (ICC) assessed agreement. Round 3 involved reprioritization of non-consensus outcomes. Results: All 20 experts completed three rounds (95% response rate). From 102 initial suggestions, 41 unique outcomes were identified. By consensus, 12 outcomes were prioritized spanning four domains: operative decision-making, non-operative management success, hepatic complications, and healthcare utilization-related outcomes. The ICC was 0.89 (95% CI 0.84 to 0.94), indicating strong inter-rater reliability. Conclusions: This rigorously developed COS for liver trauma provides standardized outcomes to guide future research and improve cross-study comparability. Adoption of these outcomes may enhance reporting consistency and facilitate evidence synthesis in liver trauma research. Study type: Consensus development study (modified Delphi). Level of evidence: V.