Trauma Commons^™

Design And Development Of A Clot Burst Pressure Device To Investigate Resuscitation Strategies, Atharwa R Mankame, Jacob B Schriner, Max A Skibber, Mitchell J George, Jessica C Cardenas, Charles S Cox, Brijesh S Gill

Faculty, Staff and Student Publications

Introduction: A reduction in clot strength is a hallmark feature of trauma-induced coagulopathy. A better understanding of clot integrity can optimize resuscitation strategies. We designed a device to gauge clot strength by pressurizing fluids over a formed clot and measuring the pressure needed to dislodge the clot. We hypothesized that this device could distinguish between clots formed in hypocoagulable and hypercoagulable states by observing differences in the clot burst pressure.

Methods: Whole blood from healthy volunteers was collected into sodium citrate tubes and was treated with heparin or fibrinogen to generate clots in a hypocoagulable or hypercoagulable state, respectively. Small …

Optogenetic Stimulation Of Ca1 Pyramidal Neurons At Theta Enhances Recognition Memory In Brain Injured Animals, John I Broussard, John B Redell, Jing Zhao, Rebecca West, Ryota Homma, Pramod K Dash

Faculty, Staff and Student Publications

The hippocampus plays a prominent role in learning and memory formation. The functional integrity of this structure is often compromised after traumatic brain injury (TBI), resulting in lasting cognitive dysfunction. The activity of hippocampal neurons, particularly place cells, is coordinated by local theta oscillations. Previous studies aimed at examining hippocampal theta oscillations after experimental TBI have reported disparate findings. Using a diffuse brain injury model, the lateral fluid percussion injury (FPI; 2.0 atm), we report a significant reduction in hippocampal theta power that persists for at least three weeks after injury. We questioned whether the behavioral deficit associated with this …

Identification Of Factors In Moderate-Severe Tbi Related To A Functional Decline In Cognition Decades After Injury, Christian Lobue, Jeff Schaffert, Kristen Dams-O'Connor, Zinat Taiwo, Angelle Sander, Umesh M Venkatesan, Therese M O'Neil-Pirozzi, Flora M Hammond, Kristin Wilmoth, Kan Ding, Kathleen Bell, C Munro Cullum

Faculty, Staff and Students Publications

OBJECTIVE: To investigate whether a functional decline in cognitive activities decades after moderate-to-severe traumatic brain injury (m-sTBI) might relate to injury features and/or lifetime health factors, some of which may emerge as consequences of the injury.

DESIGN: Secondary analysis of the TBI Model Systems National Database, a prospective, multi-center, longitudinal study of patients with m-sTBI.

SETTING: TBI Model Systems Centers.

PARTICIPANTS: Included were 732 participants rated on the cognitive subscale of the Functional Independence Measure (FIM Cognitive), a metric for everyday cognitive skills, across 3 time points out to 20 years (visits at 2-, 10-, and 20-year follow-ups; N=732).

INTERVENTIONS: …

Penyembuhan Luka: Aspek Seluler Dan Biomolekuler, Yefta Moenadjat

Department of Surgery Teaching Materials and Monographs

Mengulas aspek seluler dan molekuler penyembuhan luka di setiap fase, dimulai dari hemostasis, inflamasi dan resolusi inflamasi, proliferasi, dan maturasi. Pada bagian terakhir dulas pula gangguan proses penyembuhan luka (luka kronik, non–healing wound) yang kerap dijumpai di klinik.

Trauma Center Designation Effects On Clinical Outcomes In Pediatric Dog Bites: A Retrospective Study, Jessy Feng, Sabrina Orta, Alejandro Aquino, Lori Berry, Demba Fofana, Paul Berry

Research Colloquium

Introduction: Clinical outcomes associated with the American College of Surgeons (ACS) trauma center designation have been examined for many conditions. However, we sought to analyze the association between ACS pediatric trauma center designation and outcomes following pediatric dog bite trauma cases, which has rarely been studied.

Methods: The National Trauma Data Bank was queried to identify pediatric (0-19y) dog bite trauma patients admitted to ACS pediatric level I or II trauma centers from 2007-2016. Chi-Squared and Odds Ratio statistical analyses were used to compare the outcomes.

Results:We identified 6,196 pediatric dog bite trauma patients treated at ACS level …

Hmg-Coa Reductase Inhibitors For Traumatic Brain Injury, Kalman Katlowitz, Shankar Gopinath, Jovany Cruz Navarro, Claudia Robertson

Faculty, Staff and Students Publications

Traumatic brain injuries (TBIs) are associated with high morbidity and mortality due to both the original insult as well as the destructive biological response that follows. Medical management aims to slow or even halt secondary neurological injury while simultaneously laying the groundwork for recovery. Statins are one class of medications that is showing increased promise in the management of TBI. Used extensively in cardiovascular disease, these drugs were originally developed as competitive inhibitors within the cholesterol production pipeline. They are now used in diverse disease states due to their pleiotropic effects on other biological processes such as inflammation and angiogenesis. …

The “Cushion Effect” Revisited:, George A. Flores, Annelyn Torres-Reveron, Raul Barreda

Research Symposium

Background: It is known the pattern and severity of injuries sustained during a motor vehicle accident depend on many variables. An interesting avenue for research is obesity as a positive or negative modifier for injury distribution patterns in MVA. We hypothesize that body mass index (BMI) will influence MVC related injury patterns.

Methods: We queried STRAC data for DHR - Edinburg for the years 2014 to 2018 using CPT codes for MVC/MVA, IS > 8, age 15 - 64. Interactions between injury location, BMI, seatbelt and gender were analyzed.

Results: We had 191 detailed crashes, we found increasing age to be …

Diaphragmatic Rupture Due To Closed Thoracobdominal Trauma: A Case Report, Juan Rosales Martínez, Manlio F. Lara Duck, Antonio Gutiérrez Sierra, Netzahualcoyotl Mayek Pérez

Research Symposium

Background. Diaphragmatic injuries (DI) represent less than 1% of traumatic injuries; they are a marker of severe trauma due to associated injuries, although they often go undiagnosed as they remain hidden. If undetected, delayed herniation and strangulation of the abdominal organs into the chest cavity will result as the defect in the diaphragm is not repaired. DI occurs from penetrating or blunt trauma. The former occurs in approximately 67% of cases; direct injury to the diaphragm caused by automobile accidents has been reported. The remaining third is due to falls and crush injuries. Blunt trauma causes larger tears, even bilateral. …

Pet Imaging Of Microglia Using Pbr28suv Determines Therapeutic Efficacy Of Autologous Bone Marrow Mononuclear Cells Therapy In Traumatic Brain Injury, Supinder S Bedi, Michael C Scott, Max A Skibber, Akshita Kumar, Henry W Caplan, Hasen Xue, David Sequeira, Alison L Speer, Fanni Cardenas, Franciska Gudenkauf, Karen Uray, Amit K Srivastava, Alan R Prossin, Charles S Cox

Faculty, Staff and Student Publications

Traumatic brain injury (TBI) results in activated microglia. Activated microglia can be measured in vivo by using positron emission topography (PET) ligand peripheral benzodiazepine receptor standardized uptake values (PBR28suv). Cell based therapies have utilized autologous bone marrow mononuclear cells (BMMNCs) to attenuate activated microglia after TBI. This study aims to utilize in vivo PBR28suv to assess the efficacy of BMMNCs therapy after TBI. Seventy-two hours after CCI injury, BMMNCs were harvested from the tibia and injected via tail-vein at 74 h after injury at a concentration of 2 million cells per kilogram of body weight. There were three groups of …

Neighborhood Disadvantage And Neural Correlates Of Threat And Reward Processing In Survivors Of Recent Trauma, E. Kate Webb, Timothy D. Ely, Grace E. Rowland, Lauren A.M. Lebois, Sanne J.H. Van Rooij, Steven E. Bruce, Tanja Jovanovic, Stacey L. House, Francesca L. Beaudoin, Xinming An, Thomas C. Neylan, Gari D. Clifford, Sarah D. Linnstaedt, Laura T. Germine, Kenneth A. Bollen, Scott L. Rauch, John P. Haran, Alan B. Storrow, Christopher Lewandowski, Paul I. Musey, Phyllis L. Hendry, Sophia Sheikh, Christopher W. Jones, Brittany E. Punches, Robert A. Swor, Jose L. Pascual, Mark J. Seamon, Elizabeth M. Datner, Claire Pearson, David A. Peak, Roland C. Merchant, Robert M. Domeier, Niels K. Rathlev, Paulina Sergot, Leon D. Sanchez, Ronald C. Kessler, Karestan C. Koenen, Samuel A. Mclean, Jennifer S. Stevens, Kerry J. Ressler, Nathaniel G. Harnett

Department of Emergency Medicine Faculty Papers

IMPORTANCE: Differences in neighborhood socioeconomic characteristics are important considerations in understanding differences in risk vs resilience in mental health. Neighborhood disadvantage is associated with alterations in the function and structure of threat neurocircuitry.

OBJECTIVE: To investigate associations of neighborhood disadvantage with white and gray matter and neural reactivity to positive and negative stimuli in the context of trauma exposure.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, survivors of trauma who completed sociodemographic and posttraumatic symptom assessments and neuroimaging were recruited as part of the Advancing Understanding of Recovery After Trauma (AURORA) study between September 2017 and June 2021. Data …

The Dosing Of Mobile-Based Just-In-Time Adaptive Self-Management Prompts For Caregivers: Preliminary Findings From A Pilot Microrandomized Study, Jitao Wang, Zhenke Wu, Sung Won Choi, Srijan Sen, Xinghui Yan, Jennifer A Miner, Angelle M Sander, Angela K Lyden, Jonathan P Troost, Noelle E Carlozzi

Faculty, Staff and Students Publications

BACKGROUND: Caregivers of people with chronic illnesses often face negative stress-related health outcomes and are unavailable for traditional face-to-face interventions due to the intensity and constraints of their caregiver role. Just-in-time adaptive interventions (JITAIs) have emerged as a design framework that is particularly suited for interventional mobile health studies that deliver in-the-moment prompts that aim to promote healthy behavioral and psychological changes while minimizing user burden and expense. While JITAIs have the potential to improve caregivers' health-related quality of life (HRQOL), their effectiveness for caregivers remains poorly understood.

OBJECTIVE: The primary objective of this study is to evaluate the dose-response …

Poverty And Commercial Surrogacy In India: An Intersectional Analytical Approach, Sheela Suryanarayanan

Dignity: A Journal of Analysis of Exploitation and Violence

The destination and source countries for commercial surrogacy match world patterns of inequality. India, Nepal, Thailand, Mexico, and Cambodia banned commercial surrogacy, moving the market to other less-developed countries in South Africa and South America. India had a commercial surrogacy boom until exploitative factors led to the passage of the Surrogacy (Regulation) Bill in 2019, which banned the practice. This paper examines surrogacy's monetary, health, and emotional effects on 45 surrogate mothers in Gujarat State, India. The study revealed that a majority (63%) of the very poor women remained very poor post-surgery. Surrogate mothers in poor households had to do …

Early Prediction Of Massive Transfusion For Patients With Traumatic Hemorrhage: Development Of A Multivariable Machine Learning Model, Andrew J Benjamin, Andrew J Young, John B Holcomb, Erin E Fox, Charles E Wade, Chris Meador, Jeremy W Cannon

Faculty, Staff and Student Publications

OBJECTIVE: Develop a novel machine learning (ML) model to rapidly identify trauma patients with severe hemorrhage at risk of early mortality.

BACKGROUND: The critical administration threshold (CAT, 3 or more units of red blood cells in a 60-minute period) indicates severe hemorrhage and predicts mortality, whereas early identification of such patients improves survival.

METHODS: Patients from the PRospective, Observational, Multicenter, Major Trauma Transfusion and Pragmatic, Randomized Optimal Platelet, and Plasma Ratio studies were identified as either CAT+ or CAT-. Candidate variables were separated into 4 tiers based on the anticipated time of availability during the patient's assessment. ML models were …

How Did That Get There? A Case Series Of Adolescent Foreign Bodies, Justin Ian Hanson, Paul Bomar, Sarah Kleist, Denver Rogalla, Lori Crihfield, Scott Gutovitz

HCA Healthcare Journal of Medicine

Introduction

Pediatric foreign bodies (FBs) come in many shapes and sizes, and the method by which they enter the body can greatly impact the level of acuity at presentation. Most FBs in children are found in those younger than 5 years old, but the following 3 cases were found in adolescent patients.

Case Presentation

We report on 3 adolescent patients who presented to a single community-based emergency department with the chief complaint of abdominal pain and were found to have complications of abdominal FBs. If undiagnosed, the initial indolent courses of FBs can lead to serious complications, as shown in …

Machine Learning-Based Classification Of Chronic Traumatic Brain Injury Using Hybrid Diffusion Imaging, Jennifer Muller, Ruixuan Wang, Devon Middleton, Mahdi Alizadeh, Kichang Kang, Ryan Hryczyk, George Zabrecky, Chloe Hriso, Emily Navarreto, Nancy Wintering, Anthony J. Bazzan, Chengyuan Wu, Daniel A. Monti, Xun Jiao, Qianhong Wu, Andrew B. Newberg, Feroze Mohamed

Marcus Institute of Integrative Health Faculty Papers

BACKGROUND AND PURPOSE: Traumatic brain injury (TBI) can cause progressive neuropathology that leads to chronic impairments, creating a need for biomarkers to detect and monitor this condition to improve outcomes. This study aimed to analyze the ability of data-driven analysis of diffusion tensor imaging (DTI) and neurite orientation dispersion imaging (NODDI) to develop biomarkers to infer symptom severity and determine whether they outperform conventional T1-weighted imaging.

MATERIALS AND METHODS: A machine learning-based model was developed using a dataset of hybrid diffusion imaging of patients with chronic traumatic brain injury. We first extracted the useful features from the hybrid diffusion imaging …

Systematic Review Of Needlestick Injuries In The Operating Room: A Case For Surgical Glove Redesigning, Shalmali Mirajkar, Zachary Bauman, Bethany Lowndes

EMET Projects

Background: Sharps or needlestick injuries (NSI) occur in roughly 15% of surgeries and are largely preventable. With such injuries, healthcare workers have a high risk of exposure to blood borne pathogens. Despite the implementation of several prevention measures such as double gloving and using blunt suture needles, there is still a high prevalence of NSIs. The aim of the current study is to conduct a systematic review to identify the most vulnerable parts of the hand for needlestick injuries, the most common tasks during which injuries occurred, and the most common instrument associated with the injury.

Methods: A …

The Impact Of Police Transport Of Patients With Penetrating Traumas On Mortality, Breanne Grove

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

• 2020: For people aged 1 to 44 in the U.S., firearm-related injuries ranked in the top five leading causes of death.¹
• 2022: 44,343 total gun violence deaths, 38,593 gun injuries & 646 mass shootings²
• 1987: Philadelphia became first U.S. municipality to allow police personnel to follow a “scoop and run” policy.^3,4 Necessity for police transport came from the lack of EMS availability when firearm homicide rates rose by 123%.⁵

Trauma-Informed Care Pa-S Pilot Program Evaluation, Karyn Furcolo, Raya Patel, Mihail Petrov, Leslie Rowland

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background

Trauma stimulates the sympathetic nervous system, creates a fight-or-flight response through the hypothalamic-pituitary-adrenal axis, release of cortisol.¹ Repeated stress leads to dysregulation of this response, which can lead to altered stress susceptibility and the inability to cope with stress.² A trauma-informed approach encourages the provision of care to be based on knowledge and understanding of trauma and its widespread implications on patients lives.³

- Rather than asking "what is wrong with you," trauma-informed care encourages providers to ask "what happened to you?"⁵

Tranexamic Use And Safety In Adult Trauma Patients, Drew Frankenfield

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Problem

• Trauma is one of the top leading causes of death worldwide with about 1.9 million deaths per year.
• Mortality due to hemorrhaging trauma, specifically, accounts for 30-40% of all trauma deaths.⁸
• Mortality is due in part to trauma-induced coagulopathy which has simultaneous bleeding and clotting

Pediatric Firearm Injury Epidemiology At A Level 1 Trauma Center From 2019 To 2021: Including Time Of The Covid-19 Pandemic, Cynthia Orantes, Hei Kit Chan, Daniel Walter, Summer Chavez, Irma T Ugalde

Faculty, Staff and Student Publications

BACKGROUND: Firearms are a leading cause of death in children. The demand for firearms increased following COVID-19 "stay-at home orders" in March 2020, resulting in record-breaking firearm sales and background checks. We aim to describe the changes in pediatric firearm-related injuries, demographics, and associated risk factors at a Level 1 trauma center in Houston before and during the COVID 19 pandemic.

RESULTS: The total number of pediatric firearm-related injury cases increased during March 15th to December 31st, 2020 and 2021 compared to the same time period in 2019 (104 verses 89 verses 78). The demographic group most affected across years …