Archive for September, 2016

NTI Past Chair Jenkins and Colleague Grabo Share Lessons from War

Wednesday, September 21st, 2016

In a Scranton Journal story about how military surgeons rediscover and refine treatments from the past while saving lives on the battlefield, Donald Jenkins, MD, and Daniel Grabo, MD, talk about the concept of “damage-control surgery” conducted in austere environments.

While deployed in Oman and treating severely injured soldiers who needed blood transfusions, Dr. Jenkins had to tap the only immediate source–fresh whole blood from other soldiers–instead of stored blood components, as has been used for decades. “Trauma victims given two units of whole blood, as opposed to the typical 12 of processed blood, gained their health back more quickly,” he discovered. When Jenkins returned to practice in civilian trauma centers, he brought this lesson home to share with his fellow surgeons.

The resurgent use of whole blood and tourniquets are examples of how wartime necessities bring past wisdom to light. Thanks to Jenkins’ work, the younger Grabo and his colleagues reach for these treatments as standard protocols.

Jenkins and Grabo are both alumni of the University of Scranton and both are recipients of medical service awards: Jenkins received the American Legion’s Distinguished Service Medal and Grabo received the Romanian Medal of Honor for his efforts to save the lives of Romanian soldiers injured in Afghanistan.

Read the full story.

New Jersey Trauma Surgeon Provides a Dose of Reality in Star-Ledger Op-Ed

Tuesday, September 20th, 2016

Dr. Terrence Curran, a trauma and critical care surgeon at Morristown Memorial Hospital, wrote an op-ed for the New Jersey Star-Ledger in support of introduced legislation to raise awareness about the dangers of distracted driving. He suggests that widespread public education campaigns are needed to change behaviors and lower the toll of traumatic injury on our highways.

“The word ‘accident’ is not part of the vocabulary because trauma is a very preventable disease,” Curran says. He shares some of the realities of traumatic injury that he sees on a daily basis–for those lucky enough to live–damaged bodies, agonizing months in rehabilitation, permanent disabilities and suffering.

“I applaud Assemblyman John Wisniewski (D-Middlesex), Nicholas Chiaravalloti (D-Hudson) and Patrick Diegnan (D-Middlesex) for introducing legislation to raise awareness about the dangers of distracted driving,” Curran says, “but we should not wait for that bill to pass to increase the fight against dangerous driving behaviors.”

“While both the National Institute of Health and the Congressionally Directed Medical Research Program of the Department of Defense fund trauma research, the level of spending does not equal the magnitude of the problem,” he adds.

Read the full op-ed.

 

NTI Shares Lessons Learned Over a Decade of Study Management

Thursday, September 8th, 2016

Just published in the Journal of Trauma and Acute Care Surgery (Vol 81, No 3), “The National Trauma Institute: Lessons learned in the funding and conduct of sixteen trauma research studies” analyzes and discusses how funded researchers approached obtaining regulatory approval, enrolling patients, navigating the Exception from Informed Consent process, coordinating multiple study sites and more.

The article offers some solutions for reducing challenges and lag times inherent in the study completion timeline. Among the insights, 40 percent of the funded investigators reported delays in obtaining regulatory approval at one or more institutional levels, which had serious impacts on study management. “The time required to obtain approvals delayed the funding awards considerably and resulted in the loss of study sites, turnover in research trainees, and the need to use alternate sources of funds for research staff salaries, protocol review, and community consultation costs,” NTI found.

NTI’s insights about navigating the regulatory environment square with the findings of the National Academies of Sciences, Engineering and Medicine (NASEM) in its June 2016 report: A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. “To accelerate progress toward the aim of zero preventable deaths after injury and minimizing disability, regulatory agencies should revise research regulations and reduce misinterpretation of the regulations through policy statements” is one of the recommendations of the NASEM Committee on Military Trauma Care’s Learning Health System and Its Translation to the Civilian Sector. [Read a summary of the NASEM report HERE].

In all, NTI reports lessons that are instructive for trauma researchers in four key areas: regulatory processes, multisite coordination, adequate funding, and research infrastructure.

Needs Based Assessment of Trauma Systems Tool Unveiled in ACS Bulletin

Tuesday, September 6th, 2016

Controversy surrounding the number and location of designated trauma centers in the U.S. has led to much discussion and the emergency of two camps: one in favor of restraining the proliferation of centers and one in favor of allowing individual institutions to decide for themselves whether to pursue designation.

Following the convening of a consensus conference that reviewed the principles for trauma center designation and arrived at a set of practical methods and metrics for use in a needs based assessment, the American College of Surgeons Committee on Trauma this month released the ACS Needs Based Assessment of Trauma Systems (NBATS) tool. The tool is designed “to evaluate the need within a particular geographic area, termed a trauma service area (TSA)…[and] the number of centers needed within the TSA,” say the authors of an article about the tool in the ACS Bulletin (V101 No 9).

Incorporating critical data elements used in other system benchmarking efforts, the ACS NBATS assigns points based on population, transport time, community support and the number of severely injured patients discharged. While there is no clear evidence supporting the use of any of the specific measures proposed, “all the recommendations reflect the expert opinion of the convened group, as derived through a deliberative process,” according the Bulletin article.

The ACS COT is now circulating the tool to stakeholder groups for testing and validation. To participate in the process of review and refinement, contact Maria Alvi, Manager of Trauma Systems and Quality Programs at malvi@facs.org.

Research Sponsored by NTI Yields Insights on VTE

Tuesday, September 6th, 2016

This month, Martin A. Schreiber, MD, and his team published an article in JAMA Surgery online, following the completion of a study funded by the Department of Defense through the National Trauma Institute (NTI). The randomized clinical study compared patient outcomes for those administered standard vs. TEG-adjusted prophylactic enoxaparin dosing.  The researchers found that the time to enoxaparin initiation was more rapid than prior studies and the incidence of VTE was low and similar in both groups.

The data suggest that a difference in reaction time of more than 1 minute to initial fibrin formation comparing standard kaolin and heparinase TEGs may be associated with a decreased risk of venous thromboembolism (VTE); however, the study population may have been too limited to reveal significant results. “Low VTE incidence may be due to an early time to enoxaparin initiation and an overall healthier and less severely injured study population than previously reported,” note the researchers. Of the 185 trial participants, only 22 achieved a difference in reaction time greater than 1 minute despite increased enoxaparin dosing in the treatment group.

Risk factors for VTE were identified as older age, higher body mass index, increased Acute Physiology and Chronic Health Evaluation II score and more missed doses per patient.

As VTE is a major cause of potentially preventable death in trauma patients, related studies are important. One recommendation arising from this work is to improve compliance with dosing protocols (almost all the subjects missed at least one dose). Because the results were inconclusive, follow-on research focusing on patients with more severe injuries and prolonged hospital stays—during which there would be additional follow-up over time—is recommended. “These data demonstrate that many trauma and surgical patients are hypercoagulable at baseline and that further investigations into the effects of platelet activation, obesity, time to enoxaparin administration, and AT-III deficiency are needed.”

Shock Military Supplement Features Article on National Trauma Research Repository

Thursday, September 1st, 2016

“The National Trauma Research Repository: Ushering in a new era of trauma research” was published in the 2016 Military Shock Supplement, available online now. The article presents the Coalition for National Trauma Research (CNTR) advocacy and research activities, with a focus on the National Trauma Research Repository (NTRR), now under construction with the support of a Department of Defense grant.

The NTRR is a data-sharing platform that will facilitate exchange of research and knowledge between civilian and military researchers, reduce redundancy and maximize research funding. “Data-sharing avoids duplication of multiple, separate databases and results in conservation of research funds, ultimately leading to availability of funds for other studies and more investigators,” the authors add.

A CNTR member, the National Trauma Institute is administering the grant and managing the development of the NTRR.