Establishing Priorities in Pediatric Disaster Medicine: A Consensus Based Research Agenda in the United States

Introduction: Children in the United States are disproportionately impacted by disasters. Fourteen million children live in high risk areas for natural disasters, and over 4,300 were affected by gun violence in 2022 alone. Children have unique vulnerabilities, leading to higher morbidity and mortality compared to adults. Despite these distinctive traits, research addressing pediatric-specific needs in disaster medicine remains limited, underscoring an urgent need for a focused pediatric disaster medicine research agenda for the United States to improve outcomes and preparedness for future events. Methods: A consensus-driven pediatric disaster medicine research agenda was developed using a scoping review followed by a modified Delphi process to identify research questions. The Delphi process leverages expert input, enabling participants to refine their responses based on expert feedback until consensus is achieved. Forty-eight pediatric healthcare and disaster medicine subject matter experts participated in three rounds of surveys, discussions, and voting. The process aimed to identify key research areas and determine a prioritized consensus research agenda for pediatric disaster medicine. Results: One hundred six research questions were generated from the gaps in the literature, and an additional 155 research questions were generated by the Delphi panelists, for a total of 261 research questions generated and categorized into 20 subtopics across five main topics: Response, Recovery, Mitigation/Prevention, Preparedness, and Education. Of these, 10 subtopics were prioritized as consensus for high priority, including capacity and capability, community involvement, and health equity considerations. Critical research areas were highlighted as mental health needs, technology, and disaster-specific metrics. Conclusion: This consensus-driven research agenda is the first of its kind for pediatric disaster medicine, offering a roadmap for future research initiatives. By addressing identified gaps in disaster preparedness and response for children, this US-based agenda aims to enhance evidence-based practices, guide future research, and improve the health and safety of pediatric populations during disasters.