The AAST Research and Education Fund is funding three scholarships for 2021-2022. The scholarship recipients will receive their scholarship plaque at the 80th Annual Meeting of AAST & Clinical Congress of Acute Care Surgery in Atlanta, GA, and will present their research findings at the 81st Annual Meeting of AAST & Clinical Congress of Acute Care Surgery in Chicago, IL
Mehreen Kisat, MD
University of Wisconsin Madison
"Improving diagnosis of post-traumatic sepsis using sequencing of microbial DNA in blood"
One in four trauma patients admitted to the ICU develop sepsis during their hospital course. Injury causes a systemic inflammatory response, which mimics the clinical presentation of sepsis. Initial treatment of trauma patients manifesting an inflammatory response relies mainly on clinical judgment, until and if more definitive microbiology data become available. Lack of diagnostic certainty leads to widespread use of broad-spectrum antibiotics in this clinical population and contributes to the growing challenge of antimicrobial resistance in hospitals and the community. To address this gap, this project will evaluate a novel approach for diagnosing sepsis in trauma patients and differentiating sepsis from sterile inflammation. When successful, our results will lead to the development of a cost-effective sequencing-based blood test that will enable early recognition of sepsis in patients with trauma and rapid identification of pathogens. These diagnostic advances will help optimize the timing and choice of antimicrobial therapy for sepsis in trauma patients, potentially improving outcomes and limiting the spread of antibiotic resistance.
Samuel Carmichael, MD
Wake Forest School of Medicine
"Anti-Fibrotic Therapies for Prevention of Abdominal Adhesions"
Abdominal adhesions are fibrous bands of tissue that form between abdominal and pelvic structures following surgical interventions, trauma, and sepsis. They develop in up to 90% of cases where the abdominal cavity is opened and are considered a major driver of hospital costs and re-admissions annually. There is a lifelong risk of multiple pathologies including bowel obstruction, reoperation, female infertility, and chronic pain. Current therapies in the forms of commercial absorbable barrier films, though FDA cleared to decrease adhesions, are difficult to deploy, offer little protection for inter-organ adhesions, and have an unclear impact upon bowel obstruction, leading to infrequent usage by surgeons. Stem cell therapies have been effectively applied for a variety of other fibrotic diseases and represent an attractive option for the prevention of adhesions through the entire abdomen. Our project, at the Wake Forest Institute for Regenerative Medicine in the laboratories of Dr. Anthony Atala, utilizes a novel pre-clinical model of abdominal adhesions treated with placental stem cells, their anti-inflammatory products alone and in combination with barrier hydrogel therapies for adhesion prevention. Preliminary data have suggested a decrease in adhesion scores in treated animals versus untreated controls. Our model uniquely conceptualizes adhesions as a problem of the entire abdomen, replicating the clinical scenario managed by surgeons every day. The injection of our preventative therapies at the conclusion of an operation represents a potentially easy-to-use, clinically relevant, and translatable pathway into future human trials.
Christine M. Leeper, MD MS
University of Pittsburgh
"Characterizing Endotheliopathy in a Pediatric Trauma Cohort"
Trauma is the leading cause of death and morbidity for children in the United States and worldwide. Trauma-induced coagulopathy (TIC) is an endogenous response to injury resulting in dysregulation of the hemostatic and inflammatory systems that are associated with poor outcomes. Despite the critical importance of TIC, its mechanisms and impact in children have not been defined clearly. Pediatric clinicians often extrapolate best practice from the adult literature, however, children’s physiologic responses to injury and coagulation vary unequivocally from adults. This project will characterize traumatic endotheliopathy in children, compare markers of endothelial injury across injury patterns with a focus on traumatic brain injury, and evaluate the influence of resuscitative fluid choice on endothelial marker trend. These studies will address a critical knowledge gap in our understanding of pediatric TIC, and identify specific mechanisms and therapeutic targets that will form the basis for future multicenter studies with the goal of improving our resuscitation of critically injured children.