MedicalResearch.com Interview with:
Charles A. Karcutskie IV, MD, MA
Postdoctoral Research Fellow
University of Miami Miller School of Medicine
Department of Surgery
Divisions of Trauma, Surgical Critical Care, and Burns
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our research group at the Ryder Trauma Center have recently done several studies showing various differences in outcomes and risk based on mechanism of injury. Additionally, venous thromboembolism (VTE) is another topic that our group has focused on in the past several years. Because trauma patients are inherently at a higher risk for VTE due to the nature of their injury, we questioned whether the most important risk factors for VTE were different after blunt or penetrating trauma. At our institution, we assess VTE risk with the Greenfield Risk Assessment Profile, which is a list of several risk factors that each have weight toward an overall risk score. We took these risk factors and analyzed them individually based on mechanism of injury. We found that the factors that contribute to the VTE risk are different based on injury mechanism: After blunt trauma, transfusion status, neurologic status, and pelvic fracture contributed most. After penetrating trauma, vascular injury, severe abdominal injury, and age 40-59 years contributed most. This tells us that mechanism of injury may need to be incorporated into the risk assessment in order to discover the highest risk patients.
MedicalResearch.com: What should readers take away from your report?
Response: This is one of several studies that shows that the outcomes and risks of trauma patients vary based on mechanism of injury. This tells use that there may be a physiological reaction that differs in blunt vs penetrating trauma. The main idea to take away from this article is that mechanism of injury makes a difference. More studies need to focus on these differences and what should be done in the treatment process to account for these differences.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: As stated above, we need to further investigate why we are seeing differences based on mechanism of injury. Specifically related to this article, we must question whether our risk assessments are adequate enough, and whether adjusting the individual risk factors differently for each mechanism of injury would help assess a better risk to each patient. At our institution, we dictate ultrasound screening protocols based on our risk assessment scores. If we can correctly identify patients at a higher risk by adjusting the score with mechanism of injury, we can potentially screen them and prevent the most dreaded complication of VTE–pulmonary embolism.
MedicalResearch.com: Is there anything else you would like to add?
Response: VTE has consistently been an issue in trauma patients. While much has been done to improve risk assessment, screening protocols, and prophylaxis regimens, there is still much work to be done. The VTE rates have decreased significantly over the last few decades, however, we as a group continue to strive to further lower this. We hope that this paper is a small step toward the search for better outcomes for our trauma patients.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Karcutskie CA, Meizoso JP, Ray JJ, et al. Association of Mechanism of Injury With Risk for Venous Thromboembolism After Trauma. JAMA Surg. Published online September 28, 2016. doi:10.1001/jamasurg.2016.3116.
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