Trauma and Acute Care Surgery Research
Currently Funded Projects:
Identify the Geographic Determinants of Under Triage for Rural Traumatic Injuries and Optimize Transport to Definitive Trauma Care Within our Health System
Robust trauma systems have decreased mortality and reduced disability following injury, but such systems are more common in urban centers. The translation to regional rural trauma systems has made little progress, which is known to drive higher rural mortality after injury. Traumatic injury is a very time-sensitive event that requires rapid response to definitive care. Under triaged patients who are transported to non-trauma centers have higher mortality in the emergency department compared to leveled trauma centers. Helicopter medical transport to definitive care is known to mitigate the risk of under triage in the rural setting. We are building a system trauma data repository across eight trauma centers; integrating pre-hospital, Wisconsin Department of Health injury death related data, Trauma Registry, and electronic medical record data to visualize, geospatial map, and analyze triage in our regional trauma system. This repository intends to develop rural-focused trauma guidelines, identify under triage by geographical location, report at-risk counties, measure distance exposures, develop rural versus urban injury-related mortality outcomes, develop a strategy for definitive care in 60 minutes, and optimize trauma triage flow.
Funding Source: Raymond Goldbach Foundation
PI: Heather Rhodes-Lyons, PhD, DHS, RT(R)(ARRT)CT
Effectiveness of Recruitment, Retention Strategies, and Data Collection Quality: A Feasibility Study in Combat Athletes with Mild Traumatic Brain Injury
Combat sports are unique in that producing head trauma to the opponent is a legitimate outcome, thus the potential for acute and chronic neurological injuries is enhanced. These risks are further exacerbated by the athletes' desires to return to competition as soon as possible. If an athlete suffers a second concussion before recovering fully from the first, second impact syndrome may occur. Second impact syndrome will manifest as increased intracranial pressure from vascular engorgement and carries a mortality rate of approximately 50%. There is, therefore, a critical need to develop active interventions that will diagnose and treat mild traumatic brain injury in athletes to allow safe return to sport. Early investigations show promise in treating traumatic brain injury with hyperbaric oxygen therapy. The long-term goal of this research is to develop an effective protocol for using biomarkers to diagnosis and treat mTBI among MMA combat athletes.
Funding Source: Internally Funded Research Award
Co-I: Heather Rhodes-Lyons, PhD, DHS, RT(R)(ARRT)CT
Optimizing Chemical and Mechanical Venous Thromboembolism Prophylaxis in the Re-Bleeding Risk Traumatic Brain Injury Population: A Guideline Evaluation of the Modified Berne Norwood Criteria.
The clinical decision to administer venous thromboembolism prophylaxis is determined by an assumption of low re-bleeding risk. Findings from this study will inform clinical decisions designed to help traumatic brain injury patients avoid venous thromboembolism complications. We aim to determine the effect of venous thromboembolism prophylaxis timing in the high re-bleeding risk traumatic brain injury population based on the Modified Berne Norwood Criteria. This retrospective cohort study utilizes the American College of Surgeons-Trauma Quality Improvement Program-Participant Use File from 2017 to 2022 (N=6,714,002).
Low-, Moderate-, and High-risk: Each re-bleeding risk group was stratified by comorbid bleeding risk and into 18 exposure groups based upon very early, middle, and late venous thromboembolism prophylaxis timing.
High-Risk Population Only: There was a total of 12 exposure groups stratified by chemical or mechanical thromboembolism prophylaxis, and comorbidity based upon venous thromboembolism prophylaxis timing.
Funding Source: Marshfield Clinic Health System Foundation
PI: Heather Rhodes-Lyons, PhD, DHS, RT(R)(ARRT)CT
Optimizing Venous Thromboembolism Prevention in Cancer Patients: An Evaluation of Very Early Verses Late Prophylaxis in the Trauma Population
Patients with cancer have significantly greater risk of death from unintentional injuries. In the civilian population cancer patients receiving chemotherapy have an overall higher incidence of deep vein thrombosis (6%) and pulmonary embolism (4%). The trauma population is burdened with a high incidence of venous thromboembolism complications with 60% incidence among patients without and 30% among those with venous thromboembolism prophylaxis. The literature remains deficient regarding the impact of very early (> 24 hours) versus late venous thromboembolism prophylaxis in the chemotherapy-receiving cancer population. This study seeks to bridge this knowledge gap by analyzing American College of Surgeons Trauma Quality Program Participant Use File data (2017-2022; N=6,714,002), to optimize venous thromboembolism prevention strategies in the defined vulnerable population, thereby reducing venous thromboembolism complications and improving patient outcomes.
Funding Source: Marshfield Clinic Health System Foundation
PI: Heather Rhodes-Lyons, PhD, DHS, RT(R)(ARRT)CT
Trends in Rural Trauma Triage: Multiple Rendezvous Leading to Increased Acuity, Clinical Decline, and Mortality
In the United States, 38.4 million individuals reside over one hour away from a trauma center. In the U.S., 60 million citizens (19.3%) reside in rural communities. The proportion of potentially preventable death in traumatic injury is estimated at 39%. Rural mortality rates are reported to be three times higher than urban areas. Rural trauma systems utilize enhanced dispatch or rendezvous to maximize the regional catchment area. Rendezvous can also describe a handover between two transport methods from basic to advanced life support care level. Rural townships without immediate emergency services may rely on handover dispatch based upon prehospital EMS personal judgement for transport. Transporting high acuity rural trauma patients has unique challenges that can be characterized by variations in topography and seasonal climate zones. EMS judgement debates accessing definitive trauma care in these remote communities between a potential higher level of care transport or transportation to the nearest trauma center. The decision to call in a second dispatch and rendezvous with a higher level of care transport is a challenge frequently faced by rural EMS who are often the only guaranteed health service in underserved rural communities. This single-center Trauma Registry study was conducted from (23 years) January 1, 2000, to December 31, 2023. The data collected patient demographics, injury details, pre-hospital transport, morbidity, and mortality. The inclusion criteria were all trauma patients who were directly transported and were grouped into categories based upon the number of EMS rendezvous. This analysis utilizes regression models with the primary outcomes; emergency department disposition to the intensive care unit or morgue; Glasgow Coma Scale and shock index ratio on arrival. Each model controls for age, sex, payor, injury type, and injury severity score.
Funding Source: Marshfield Clinic Health System Foundation
PI: Heather Rhodes-Lyons, PhD, DHS, RT(R)(ARRT)CT
Morbidity and Mortality Based on Traumatic Brain Injury Size and Type: A National Analysis|
Traumatic brain injuries are a significant cause of morbidity and mortality in the United States with the CDC reporting 214,110 hospitalizations resulting from a Traumatic brain injury in 2020 alone. After discharge, patients face significant morbidity with one study finding that 1.1% of the US population was living with a long-term disability from a traumatic brain injury. These factors are all associated with significant costs with in-hospital costs being as high as $401,808. Despite some research that seeks to identify risk factors for poor outcomes in traumatic brain injury patients, there remains significant gaps. There is currently minimal research related to the outcomes of traumatic brain injury patients based on the size and type of traumatic brain injury. This limits the ability to provide a strong evidence-based clinical management strategy for a significant population of patients. Using the American College of Surgeons Trauma Quality Program Participant Use File (2017-2022; N=6,714,002) dataset of patients who received trauma care, this study aimed to address this by predicting the likelihood of morbidity and mortality outcomes based upon the type and size of traumatic brain injury, with and without the presence of a skull fracture. This will inform future clinical decisions to help traumatic brain injury patients avoid adverse outcomes.
Funding Source: Marshfield Clinic Health System Foundation
PI: Heather Rhodes-Lyons, PhD, DHS, RT(R)(ARRT)CT
Geographic Determinants of Under Triage and Clinical Decline in Pediatric Agricultural Injuries: A Rural Trauma Experience
An EMS preference exists in minimizing transport distance, irrespective of patient need or hospital designation, particularly in rural areas. This new proposed project in pediatric agricultural research will identify under triage, delay in definitive care, and clinical decline comparative to transport distance in our rural community. We aim to evaluate transport distance and map injury ZIP codes with under triage rate and clinical decline markers among pediatric agricultural related injuries. This single-center Trauma Registry study will be conducted from (23 years) January 1, 2000, to December 31, 2023. The data will collect patient demographics, injury details, morbidity, mortality, in-hospital complications, and injury ZIP codes. The inclusion criteria will be all pediatric (< 18 years) Trauma Registry patients with an ICD farm related injury. The analysis will utilize logistic and linear regression models with the outcome of distance in miles, mortality, ICU length of stay, ED disposition to ICU, and ED disposition to OR. The primary effect variables will include under triage, shock index ratio, and Glasgow Coma Scale that will be controlled by age, gender, race, payor, mode of transport, and injury severity score.
Funding Source: NCCRAHS-Farm Medicine
PI: Heather Rhodes-Lyons, PhD, DHS, RT(R)(ARRT)CT
Robotic Surgery in Acute Care Surgical Patients: A Focus on Patient Selection and Complications
In the United States, there are more than 850,000 emergency general surgeries performed annually with a representation of 7% of all hospitalizations. Emergency general surgeries have a disproportionately high risk for complications and mortality. More research is needed to describe robotic-assisted surgery impact on preventing complications and optimizing outcomes in this challenging setting. There is no clear guidance for the selection of acute care surgical patients and robotic procedures, or evidence-based decisions based upon unique patient characteristic that may likely increase adverse outcomes with robotic-assisted surgery. In the acute care settings, where timely and effective interventions are critical, the utilization of robotic technology holds great promise. However, ensuring appropriate risk stratification, patient selection, and mitigating preventable complications are crucial for optimizing outcomes in this challenging setting. Using the local electronic medical records of patients who have received surgical care, the specific aim of this study is to investigate the impact of robotic surgery in acute care surgical practice, focusing on risk stratification, patient selection, preventable complications, morbidity, and mortality. We hope to give evidence-base guidance for clinical decisions in robotic-assisted surgery based on proper patient selection by identifying a patient risk profile, risk of surgery type, perioperative risk and ensuring robotics is the correct modality for the case in both elective and acute general surgery.
Funding Source: Marshfield Clinic Health System Foundation
Site PI: Heather Rhodes-Lyons, PhD, DHS, RT(R)(ARRT)CT
Recently Completed Projects
