Archive for the ‘Trauma Research’ Category

Mangled Extremity Score Not a Reliable Predictor of Amputation

Thursday, March 2nd, 2017

In a study with results published in the Journal of Trauma and Acute Care Surgery (Vol. 82, No. 3), the PROspective Observational Vascular Injury Treatment (PROOVIT) group found that “Blunt injuries, vessel transection, popliteal injuries, and concomitant nerve and orthopedic injuries were associated with the need for amputation, and were more predictive than an isolated [Mangled Extremity Severity Score] MESS.”

The group employed the PROOVIT database to re-evaluate the MESS after other tests of the scoring system, originally developed in 1990, questioned its validity. Since the introduction of the MESS, researchers have developed alternative scoring systems including the Limb Salvage Index; the Predictive Salvage Index; the Nerve, Injury, Ischemia, Soft-tissue Injury, Skeletal Injury, Shock and Age of Patient Score (NISSA); and the Hannover Fracture Scale. And military surgeons have concluded that the MESS is not useful in battlefield-related injury classification.

“Prehospital use of a tourniquet, damage control, balanced resuscitation, use of vascular shunts to reduce ischemia time, early fasciotomy, aggressive wound care, mircrosurgical abilities, and advanced tissue coverage techniques have all contributed to our increased ability to care for patients with mangled extremities,” they concluded. “We advocate for the use of a team approach to decision making regarding limb salvage rather than the use of a score.”

PROOVIT investigators, funded by the Department of Defense through the National Trauma Institute, continue to evaluate a growing pool of data in order to inform practice decisions and assure the best outcomes for patients with limb-threatening mangled extremities.

“The optimal management of peripheral vascular injury remains a complex issue,” said Joe DuBose, MD, the study primary investigator. “Our effort was designed to re-examine the validity of standardized grading systems in predicting outcome for these injuries. I think the work proved useful in determining that we need additional research on the topic. It is our hope that the further maturation of the PROOVIT registry will provide some much needed answers in this important area of trauma care.”

Read the article in JOT.

Novel Markers of Mortality Identified in Combat Trauma

Friday, February 24th, 2017

This month, NTI board member, Deputy Chair of Surgery and Division Head of Critical Care and Acute Care Surgery at the University of Minnesota, Greg J. Beilman, MD, and colleagues published a study evaluating plasma metabolomics in combat trauma in the Journal of Trauma and Acute Care Surgery (Vol 82, No 2). The researchers hypothesized that succinate was a marker of mortality and sought to identify other biomarkers of mortality and injury severity.

Extracting and evaluating demographics and outcome data from the Joint Trauma Systems database, Beilman et al. determined that succinate and lactate are major markers of mortality and injury severity, as is hypoxanthine. “In short,” report the researchers, “VIP-identified metabolites associated with trauma are positively correlated with clinical markers known to increase with severe bleeding and are negatively correlated with clinical markers known to decrease with traumatic hemorrhage.”

The work confirms previous findings in porcine models and may lead to testable treatments for the outcomes of trauma in both civilian and military patients.

Read the article: Assessment of key plasma metabolites in combat casualities

CDC Reports on Higher Death Rates in Non-Metro Areas

Tuesday, January 17th, 2017

The January 13th edition of the CDC’s Morbidity and Mortality Weekly Report (MMWR) provides an assessment of the leading causes of death in non-metro and metro areas between 1999 and 2014, concluding that higher rates of death occur in non-metro areas of the U.S.

After calculating age-adjusted death rates and potentially excess death in metro and non-metro areas for the five leading causes of death–heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke–the CDC concluded that more than half of all deaths (57.5%) from unintentional injury, specifically, that occur outside metro areas were potentially excess (potentially preventable). In metro areas, that rate is 39.2%.

The report suggests the higher rate of excess death in more rural areas of the country may be related to a variety of factors including less access to health care services, further distance to trauma care centers, and reduced EMS services as well as behavioral factors like physical inactivity during leisure and lower use of seat belts.

“Routine tracking of potentially excess deaths in nonmetropolitan areas might help public health departments identify emerging health problems, monitor known problems, and focus interventions to reduce preventable deaths in these areas,” the report concludes.

NTI Is Awarded $4.6M Contract for Repository and Military-Relevant Research

Wednesday, October 7th, 2015

Research Repository Fact SheetThe National Trauma Institute today announced the award of a $4.6 million Department of Defense Extramural Medical Research grant to develop a National Trauma Research Repository (NTRR) and fund three promising studies with both military and civilian trauma care implications, whose results will be the first to populate the repository.

“Collaboration between military treatment centers and civilian trauma research centers that focuses on combat casualty research priorities is critical to advancing patient care in both military and civilian contexts,” said NTI’s Executive Director Sharon Smith. “With this contract, the DOD is keeping the country’s wounded soldiers as its highest priority by enabling highly qualified civilian trauma centers to continue and add to the work conducted within its Combat Casualty Care Research Program.”

The grant will fund multi-center studies aimed at some significant knowledge gaps, including an evaluation of Ketamine as an alternative to narcotics in treating severe pain following traumatic injury; development of a surgical airway training system to help combat medics, EMT-paramedics, emergency physicians and surgeons develop surgical competency; and a study of a variety of therapies for mitigating vascular trauma injury that results in non-compressible hemorrhage, the leading cause of death on the modern battlefield.

A follow-on to earlier NTI work, a National Trauma Research Repository will enable the synthesis of these and other study data for maximum use. “Because clinical trauma research has largely been accomplished through disconnected efforts, too often these efforts see delays and duplications, inefficiencies and increased costs,” said Dr. Donald Jenkins, the Mayo Clinic’s Director of Trauma, NTI Board member and Principle Investigator on this project. “Among many other benefits, the NTRR will enable repurposing of data to answer additional research questions and provide for pooled data sets with the statistical power necessary to improve statistical significance.

“The ability to make aggregated research data widely available to clinical investigators is critical to reform trauma research and care,” added Jenkins. “While the practice of medicine should be evidence-based, within the field of trauma there is surprisingly little evidence to support clinical practice. A research data repository will ensure maximum utilization of trauma data for translation into evidence-based practice.”

Learn more about the benefits of research repositories.



VCU Researchers Consider Vitamin C as Hemorrhagic Shock Treatment

Friday, November 7th, 2014

With a grant from the Department of Defense, researchers at Virginia Commonwealth University will begin studying the effect of high doses of vitamin C on platelet function. Their hope is that the treatment will retard organ failure due to heavy blood loss.

This study follows one that looked at using vitamin C to treat septic lung injury resulting from infection.  As published in the Journal of Translational Medicine in January, researchers found that high doses of vitamin C prevented the inflammatory responses from sepsis.

Read More.

NTI-Funded Study Finds that Clinical Practice Compliance Saves Lives

Tuesday, September 2nd, 2014

Trauma Center compliance with recommended clinical practices is not uniform, and increased adherence leads to improved patient outcomes, finds recently published research conducted by Shahid Shafi, MD, MPH, FACS, and colleagues.

Shafi’s study, funded with a grant from the National Trauma Institute, sought to determine whether variations in specific clinical practices affect patient outcomes. The authors focused on a set of 22 measurable clinical practices related to traumatic brain injury, hemorrhagic shock, pelvic fractures and long-bone external fractures.

The retrospective observational study conducted with data from five Level 1 Trauma Centers indicated that 100% compliance with the 22 commonly recommended practices was associated with a 58% reduction in mortality.

Read more in the Journal of the American College of Surgeons 2014;219:189-198.

NTI-Funded Research Provides Guidance on Iron Supplementation for Critically Injured Patients

Tuesday, July 15th, 2014

Research funded by the National Trauma Institute finds that routine IV iron supplementation of anemic, critically ill trauma patients is not recommended.

Nearly all trauma patients admitted to the ICU are anemic, and the anemia is associated with poor outcomes, yet current therapies for ICU anemia are unsatisfactory. Intensivists inconsistently prescribe iron supplementation for critically ill patients, and it has been unclear whether the practice can overcome the iron debt enough to impact the patient positively. Also unclear is the relationship between iron supplementation and risk of infection.

The research conducted by Fredric M. Pieracci, MD, MPH, at the UC Denver medical campus and three participating academic sites set out to determine whether iron supplementation of anemic trauma patients positively affects outcomes.

They found that while supplementation increased the serum ferritin concentration significantly, it had no discernable effect on transferrin saturation, iron-deficient erythropoiesis, hemoglobin concentration or packed red blood cell transfusion requirements.

The research is published in Critical Care Medicine.

Nanoparticles May Control Internal Bleeding

Tuesday, July 1st, 2014

The Proceedings of the National Academy of Sciences reports on a new type of artificial platelet that can be injected into the body to help form blood clots more quickly.

According to Erin Lavik, study author and an associate professor of biomedical engineering at Case Western Reserve University in Cleveland, in the presence of extensive internal bleeding, there are often not enough natural resources to stop the loss of blood. But hemostatic nanoparticles, made from short polymer chains and peptides, act like tiny bridges, connecting the body’s activated platelets so that more and more cells can band together and form stronger blood clots.

In animal trials, the particles increased the survival rate of treated mice to 95 percent, compared to a 60 percent survival rate in the untreated mice.  And the injected mice survived for several weeks post-injection, indicating long-term success.

If efficacy is proven in human trials, the product could have significant application both on the battlefield and at home. Blast exposure resulting in uncontrolled bleeding accounts for 79 percent of all combat-related injuries. It is the leading cause of death on the battlefield.  What’s more, uncontrolled bleeding from car accidents, blows and falls is one of the leading causes of death among Americans.

Read more.

NTI Study Refutes Dogma of Ventilator Bundle Use to Prevent Ventilator Associated Pneumonia

Friday, March 1st, 2013

Ventilator associated pneumonia (VAP) is the most common serious infection that occurs in severely injured patients. For those who develop VAP, approximately 20% will not survive. While the mainstay of treatment of VAP remains antibiotic therapy, the emphasis from healthcare organizations has been on VAP prevention, and the Institute for Healthcare Improvement has advocated a “bundle” of care maneuvers to help prevent VAP, including stress ulcer prophylaxis, deep venous thrombosis prophylaxis, head-of-bed elevation, and daily sedation vacation with weaning assessment. Although the use of the ventilator bundle has been widely accepted, there is little evidence of its effectiveness. Furthermore, the Centers for Medicare and Medicaid Services have determined that VAP may be preventable with ventilator bundle use, and has threatened to reduce or eliminate payment to hospitals when a patient develops VAP.

The National Trauma Institute’s first completed research study analyzed the efficacy of the ventilator bundle in prevention of ventilator associated pneumonia in trauma patients who were in the Intensive care Unit (ICU) on a ventilator for at least two days. The research study, highlighted in the February issue of the Journal of Trauma and Acute Care Surgery, and first presented at the AAST Annual Meeting in Kauai, was led by Dr. Martin Croce at the University of Tennessee in Memphis, and enrolled over 600 patients at six Level 1 trauma centers nationally.

This study shows that VAP is more likely to occur in male patients, and those with severe chest injury, regardless of the ventilator bundle. Moreover, the study found that use of the ventilator bundle does not prevent or reduce the occurrence of VAP. Ultimately, critical analysis of dogma is important for patient care, and new, innovative means of ventilator associated pneumonia prevention are needed.

San Antonio Burn Patients Test Spray-On Skin

Monday, February 6th, 2012

The U.S. Army Institute of Surgical Research is a trial site for a new treatment to regenerate the skin cells of burn patients. The process involves a doctor combining the patient’s skin with an enzyme solution and then spraying it back on to the treated burn site.

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