Medical Student Research Fellowship for Summer 2009

Mentor: Herb Phelan, MD, FACS
Department: Surgery, Division of Burns/Trauma/Critical Care
Room number: E5.508A
Mail Code: E5.508A, zip 75390-9158
Phone number: 214-648-6841
E-mail: herb.phelan@utsouthwestern.edu

Project I title: Evaluating the effect of the age of leukoreduced red cell transfusion products on outcomes after injury

Human subjects IRB approved project number (where applicable): 042007-026 (please note that we are currently in the process of renewing it as it expires 3/11/09.

Animal subjects IRB approved project number (where applicable): NA

Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects) Patient-based prospective observational study

Brief Description of Project:

While it is clear that non-leukoreduced blood which has sat in the blood bank for prolonged periods of time (ie, "aged") causes increased rates of infection, multiple organ failure, and death when transfused to ICU patients, it is unclear whether the process of leukoreduction abrogates this age effect. As Parkland exclusively transfuses leukoreduced blood to its trauma population, we are in a unique situation to be able to address this question.

This study involves prospectively tracking the clinical course of trauma patients who have received 4 or more units of leukoreduced blood in their first 24 hours of hospitalization and survived their initial resuscitation. The student will be responsible for checking with the post-call trauma team every day to find the location of any trauma admissions meeting these qualifications. The student will then review the ICU flow sheet, patient chart, and computer system in order to complete a data sheet on them every day tracking infectious complications, multiple organ dysfunction, and death. The student will do so for the remainder of their hospital stay. The student will also go to the blood bank and access their computer records in order to track the age of blood transfused to these patients. The student will not be responsible for getting any consents as a waiver of consent has already been granted by the IRB. An initial patient assessment at the time of enrollment will generally take about 30 minutes, and each subsequent day's data sheet collection should take about 5 minutes per patient.

We have currently enrolled 84 patients, and hope to enroll a total of 300.

Project II title: Does adding a domestic violence screen to scheduled substance abuse screening result in increased sensitivity for detecting domestic violence in female trauma patients?

Human subjects IRB approved project number (where applicable): 042009-095

Animal subjects IRB approved project number (where applicable): NA

Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects)

Patient-based

Brief Description of Project:

Among women of child bearing age in the United States, domestic violence (DV) is the leading cause of serious injury, the second leading cause of death, and occurs at a higher rate than motor vehicle collision and mugging combined. While women experience fewer violent crimes overall then men, they are five to eight times more likely than men to be victimized or killed by an intimate partner. The prevalence of DV in the female trauma population is thought to be one patient in three.

Parkland Memorial Hospital (PMH) has a system in place for victims of violence known as the Victim Intervention Program (VIP). This program provides services to patients who have been victims of family violence, intimate partner violence, or rape either recently or in the past. While these services are a valuable resource for patients who have been identified, effective screening has been difficult to achieve. Screening for DV among patients admitted to the PMH trauma service is slated to be done at the time of arrival on the ward by the admitting nurse. This DV screen consists of 2 questions: "Is someone you love hurting you?", and "Are you fearful of someone in your home?" These questions are supposed to be asked during a battery of 81 questions ranging from vaccination status to religious preferences. At the time of admission, however, patients are frequently in pain, medicated, distraught, or intoxicated. The nurse is simultaneously juggling multiple responsibilities, and the amount of time that he/she has to dedicate to this particular part of the admission process can be highly variable. It seems intuitive that as the degree of multitasking on the part of the screener increases, the potential for a drop off in the quality of the screening process becomes more likely.

Conversely, PMH currently employs a protocol-driven screening process for alcohol abuse in every admitted trauma patient known as "SBIRT" (Screening, Brief Intervention, and Referral for Treatment"). This examination is conducted by trained substance abuse counselors in isolation from other clinical responsibilities, and after the patient has been on the ward for a variable period of time. Any lingering effects of alcohol have been allowed to disappear, and the setting is structured in a way so as to be "distraction free". Frequently patients have had time to ruminate on the behaviors and actions that resulted in their admission to the trauma service, and are more reflective than in the first hectic minutes after arrival on the ward. It is our hypothesis that by linking a validated DV screen, the Partner Violence Survey, to this scheduled screen for alcohol abuse delivered by certified counselors, a higher overall rate of referrals for DV support services will result.

Previous Research Activities or Publications with Medical Students:

At my previous institution, I completed a retrospective study of this same topic with 4 medical students, and that manuscript is currently in review at Journal of Trauma with the students as co-authors. Additionally, Randy Friese initiated the study in question and had the participation of 2 students (Tiffany Jan and Jessi Howard).