November 2024 Cutting Edge Newsletter

Editor’s Note

Written by: Shannon Marie Foster, MD, FACS and Ronald Stewart, MD

Pediatrics Committee

Timing of Tracheostomy in Children with Traumatic Brain Injury  

Written by: Y.H. Andrew Wu, MD¹, H Patrick Mallany, DO², Lara K Reichert, MD MPH², Mary Edwards, MD MBA¹

¹ Department of Surgery, Albany Medical Center, Albany, NY

² Department of Otolaryngology, Albany Medical Center, Albany, NY

Introduction:

Early tracheostomy for adults, adolescents and older children with traumatic brain injury (TBI) has demonstrated improved clinical outcomes and enhanced resource utilization.  These benefits include shortened hospitalization, fewer ICU and ventilator days, lower morbidity, faster transition to rehabilitation services and lower cost ^1-8. In adults, there is also limited evidence that early tracheostomy may incur a mortality benefit⁹.  However, its use in traumatically injured young children, particularly toddlers and infants, is not as well established. This article discusses known risks and benefits influencing the decision to perform early tracheostomy in younger pediatric patients with TBI.

Benefits of Early Tracheostomy in Traumatic Brain Injury:

Most studies loosely define early tracheostomy in patients with severe TBI as occurring within 3–21 days.  However, this varies by region and patient population¹⁰.

Early tracheostomy in adults, typically defined as prior to 7-8 days after injury, is a well-established practice and is supported by 3 decades of data demonstrating improved outcomes (Table 1)^4,9,11-13.  Studies consistently show earlier tracheostomy is associated with shorter ICU stays and fewer ventilator days¹⁴. Lower rates of respiratory complications have also been demonstrated in several studies^4,9,12 One study identified significantly lower mortality rates among patients who received an early tracheostomy⁹. These findings have prompted a further shift in practice at some centers, where tracheostomy is performed immediately after decompressive craniectomy under the same anesthesic.¹⁴ The clear trend in adult TBI management increasingly favors performing tracheostomies earlier, with the goals of improved outcomes, resource conservation and accelerated recovery.

For pediatric patients with TBI, early tracheostomy is typically described as prior to 14-21 days after intubation. This practice has similarly demonstrated decreased ICU/hospital length of stay and ventilator days according to multiple retrospective studies. However, these studies have produced inconsistent findings regarding the impact of early tracheostomy on respiratory complications, pneumonia, and mortality ^15-17 (Table 2). One notable finding is variability based on age.  McLaughlin et al. observed benefits of early tracheostomy in pediatric patients with severe TBI, but cautioned these findings might not extend to infants with head trauma resulting from abuse due to the small number of infants who underwent early tracheostomy in this cohort and the inability to propensity match them.¹⁶ Similarly, a study that reviewed the Healthcare Cost and Utilization Project Kids' Inpatient Database, reported pediatric patients receiving early tracheostomy after TBI were significantly older (16.5 vs. 11.4 years, p < 0.001). ¹⁷ The authors attributed this difference to a likely higher incidence of severe TBI in this age group.  Overall, generalization of the benefits seen with early tracheostomy in adolescents and older children with severe TBI to very young children is difficult based on the limited experience in current publications.

Special considerations regarding tracheostomy in young children:

In very young children and infants, tracheostomy is associated with several serious complications. Early accidental decannulation is among one of the most critical, with reported rates as high as 22% within the first few days following placement¹⁸. This requires prompt management to avoid life-threatening airway loss. Prevention requires close monitoring, and often deep sedation for several days. Bleeding rates have been reported to occur in 1.8% to 15% of cases, with major bleeding occurring in up to 5% of cases¹⁹. In one systematic review from South America, morbidity from pediatric tracheostomy was 40% and mortality 6%.²⁰ Mortality was mostly related to airway obstruction and accidental decannulation, which is more common in young children.  A study of 206 tracheostomies performed on patients under age two years reported a mortality rate of 6% and a major morbidity rate of 24% at 30 days, including cases of pneumonia and sepsis²². Other large database studies quote a rate of 8% for overall complications, with higher rates among younger children²¹. Intraoperative complications include accidental injury to the pleura leading to pneumothorax (1-3% of cases¹⁸) and rarely complete loss of airway support during the procedure, particularly at the time of tube exchange.  Postoperatively, tracheostomy site infection is well described, along with pressure injury to surrounding soft tissues²². Longer term, mucus plugging, which is inherently more common in smaller airways, occurs in about 25% of tracheostomy patients²³ and can be life threatening.   Some studies of infants undergoing tracheostomy additionally report a significant burden on families due to unplanned returns to the ED ^24,25.  However, all these papers primarily reflect a population of children undergoing tracheostomy for primary congenital neurologic or chronic pulmonary conditions, other congenital conditions and/or prematurity.  Therefore, the results may not be generalizable to children with TBI.   

Longer term complications also include tracheal stenosis, erosion, or dilation. Development of tracheal stenosis after pediatric tracheostomy occurs in up to 25% of patients, with younger patients being at the highest risk.²⁶  Regular follow-up and interval bronchoscopic evaluation is essential for early identification, allowing for timely intervention in order to prevent morbidity or even mortality.  Stenosis may be effectively treated with tracheal dilation, but may require surgical resection and airway reconstruction, depending on severity of the condition. Finally, pediatric patients with tracheostomies may experience persistent neutrophilic airway inflammation, complicating their overall respiratory health²². Management of airway inflammation may involve the use of inhaled corticosteroids or other anti-inflammatory medications tailored to the individual needs of the patient.

As small children are at higher risk of immediate and long-term complications, comprehensive training for caregivers and healthcare providers on tracheostomy care is essential. This training should cover topics such as emergency protocols, tube management, and routine care to prevent complications¹⁹. Follow up with a multidisciplinary team, including specialists such as pulmonologists, otolaryngologists, and respiratory therapists, is crucial for early detection and management of potential complications²⁷. Maintaining adequate humidification and minimizing contamination of the airway is vital in reducing the incidence of mucus plugging and subsequent infections.²³  Lastly, providing access to mental health resources for both the child and their family is essential in mitigating the emotional challenges associated with living with a tracheostomy. Support groups and counseling services can play a significant role in enhancing the overall well-being of affected families.²⁸

Conclusion:

While there is significant data supporting the practice of early tracheostomy in severe TBI for adults, adolescents and older children, the experience in younger children, toddlers and infants is limited. More study is needed to determine optimal timing in this age group.  Given the reported complications and morbidity in very young patients undergoing tracheostomy for chronic medical and congenital conditions, the decision to proceed with tracheostomy should be made with some caution.  It is reasonable to raise the threshold for timing of tracheostomy in very young patients with TBI and to individualize the decision to perform tracheostomy based on the clinical and social conditions surrounding each patient.

Reference:

1. Lee JH, Koo CH, Lee SY, et al. Effect of early vs. late tracheostomy on clinical outcomes in critically ill pediatric patients. Acta Anaesthesiol Scand. Oct 2016;60(9):1281-8. doi:10.1111/aas.12760
2. Hosokawa K, Nishimura M, Egi M, Vincent JL. Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Crit Care. Dec 4 2015;19:424. doi:10.1186/s13054-015-1138-8
3. Holscher CM, Stewart CL, Peltz ED, et al. Early tracheostomy improves outcomes in severely injured children and adolescents. J Pediatr Surg. Apr 2014;49(4):590-2. doi:10.1016/j.jpedsurg.2013.09.002
4. Alali AS, Scales DC, Fowler RA, et al. Tracheostomy timing in traumatic brain injury: a propensity-matched cohort study. J Trauma Acute Care Surg. Jan 2014;76(1):70-6; discussion 76-8. doi:10.1097/TA.0b013e3182a8fd6a
5. Wang HK, Lu K, Liliang PC, et al. The impact of tracheostomy timing in patients with severe head injury: an observational cohort study. Injury. Sep 2012;43(9):1432-6. doi:10.1016/j.injury.2011.03.059
6. Zagli G, Linden M, Spina R, et al. Early tracheostomy in intensive care unit: a retrospective study of 506 cases of video-guided Ciaglia Blue Rhino tracheostomies. J Trauma. Feb 2010;68(2):367-72. doi:10.1097/TA.0b013e3181a601b3
7. Holloway AJ, Spaeder MC, Basu S. Association of timing of tracheostomy on clinical outcomes in PICU patients. Pediatr Crit Care Med. Mar 2015;16(3):e52-8. doi:10.1097/PCC.0000000000000336
8. Pizza A, Picconi E, Piastra M, Genovese O, Biasucci DG, Conti G. Early versus late tracheostomy in pediatric intensive care unit: does it matter? A 6-year experience. Minerva Anestesiol. Aug 2017;83(8):836-843. doi:10.23736/S0375-9393.17.11681-0
9. Azari Jafari A, Mirmoeeni S, Momtaz D, et al. Early Versus Late Tracheostomy in Patients with Traumatic Brain Injury: A US Nationwide Analysis. Neurocrit Care. Apr 2024;40(2):551-561. doi:10.1007/s12028-023-01778-2
10. Holevar M, Dunham JC, Brautigan R, et al. Practice management guidelines for timing of tracheostomy: the EAST Practice Management Guidelines Work Group. J Trauma. Oct 2009;67(4):870-4. doi:10.1097/TA.0b013e3181b5a960
11. Ahmed N, Kuo YH. Early versus late tracheostomy in patients with severe traumatic head injury. Surg Infect (Larchmt). Jun 2007;8(3):343-7. doi:10.1089/sur.2006.065
12. Mubashir T, Lai H, Oduguwa E, et al. Effect of tracheostomy timing on outcomes in patients with traumatic brain injury. Proc (Bayl Univ Med Cent). 2022;35(5):621-628. doi:10.1080/08998280.2022.2084780
13. Villemure-Poliquin N, Costerousse O, Lessard Bonaventure P, et al. Tracheostomy versus prolonged intubation in moderate to severe traumatic brain injury: a multicentre retrospective cohort study. Can J Anaesth. Sep 2023;70(9):1516-1526. Comparaison de la tracheotomie et de l'intubation prolongee en cas de traumatisme craniocerebral modere a grave : une etude de cohorte retrospective multicentrique. doi:10.1007/s12630-023-02539-7
14. Kumar R, Zenian MS, Maeng TY, Fadzil F, Mohd Azli AN. Patient Outcomes following Immediate Tracheostomy and Emergency Decompressive Craniectomy in the Same Setting. Int J Environ Res Public Health. Nov 26 2022;19(23)doi:10.3390/ijerph192315746
15. Sheehan BM, Grigorian A, Gambhir S, et al. Early Tracheostomy for Severe Pediatric Traumatic Brain Injury is Associated with Reduced Intensive Care Unit Length of Stay and Total Ventilator Days. J Intensive Care Med. Nov 2020;35(11):1346-1351. doi:10.1177/0885066619870153
16. McLaughlin C, Darcy D, Park C, et al. Timing of tracheostomy placement among children with severe traumatic brain injury: A propensity-matched analysis. J Trauma Acute Care Surg. Oct 2019;87(4):818-826. doi:10.1097/TA.0000000000002237
17. Salik I, Das A, Naftchi AF, et al. Effect of tracheostomy timing in pediatric patients with traumatic brain injury. Int J Pediatr Otorhinolaryngol. Jan 2023;164:111414. doi:10.1016/j.ijporl.2022.111414
18. D'Souza JN, Levi JR, Park D, Shah UK. Complications Following Pediatric Tracheotomy. JAMA Otolaryngol Head Neck Surg. May 1 2016;142(5):484-8. doi:10.1001/jamaoto.2016.0173
19. Mitchell RB, Hussey HM, Setzen G, et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. Jan 2013;148(1):6-20. doi:10.1177/0194599812460376
20. Lubianca Neto JF, Castagno OC, Schuster AK. Complications of tracheostomy in children: a systematic review. Braz J Otorhinolaryngol. Nov-Dec 2022;88(6):882-890. doi:10.1016/j.bjorl.2020.12.006
21. Newton M, Johnson RF, Wynings E, Jaffal H, Chorney SR. Pediatric Tracheostomy-Related Complications: A Cross-sectional Analysis. Otolaryngol Head Neck Surg. Aug 2022;167(2):359-365. doi:10.1177/01945998211046527
22. Powell J, Powell S, Mather MW, et al. Tracheostomy in children is associated with neutrophilic airway inflammation. Thorax. Oct 2023;78(10):1019-1027. doi:10.1136/thorax-2022-219557
23. Roberts J, Powell J, Begbie J, et al. Pediatric tracheostomy: A large single-center experience. Laryngoscope. May 2020;130(5):E375-E380. doi:10.1002/lary.28160
24. Hebbar KB, Kasi AS, Vielkind M, et al. Mortality and Outcomes of Pediatric Tracheostomy Dependent Patients. Front Pediatr. 2021;9:661512. doi:10.3389/fped.2021.661512
25. Kukora SK, Van Horn A, Thatcher A, Pace RA, Schumacher RE, Attar MA. Risk of death at home or on hospital readmission after discharge with pediatric tracheostomy. J Perinatol. Aug 2023;43(8):1020-1028. doi:10.1038/s41372-023-01721-5
26. Suresh R, Roohani C, Wang CS, Kou YF, Johnson RF, Chorney SR. Subglottic Stenosis After Pediatric Tracheostomy. Laryngoscope. Aug 27 2024;doi:10.1002/lary.31736
27. Murphy Salem SL, Perez JM, Staffa SJ, Duncan CN, Graham RJ. Outcomes for Pediatric Oncology and Hematopoietic Stem Cell Transplantation Patients Who Undergo Tracheostomy Placement: A Pediatric Health Information System Database Cohort Study, 2009-2020. Pediatr Crit Care Med. Jun 1 2024;25(6):e283-e290. doi:10.1097/PCC.0000000000003478
28. La-Anyane OM, Whitney NB, Harmon KA, Karas AF, Jeffe JS, Tragos C. Tracheostomy, the Not So Definitive Airway?: Tracheostomy Morbidity in Pediatric Craniofacial Patients. J Craniofac Surg. Nov-Dec 01 2023;34(8):2413-2416. doi:10.1097/SCS.0000000000009627
29. Butler EK, Killien EY, Groner JI, Arbabi S, Vavilala MS, Rivara FP. Optimal Timing of Tracheostomy in Injured Adolescents. Pediatr Crit Care Med. Jul 1 2021;22(7):629-641. doi:10.1097/PCC.0000000000002681

The Diversity, Equity, and Inclusion Committee and the Associate Member Council

Reflections from the Diversity Essay Contest

Essay authors:

Zachary Tran, MD
Surgical Critical Care / Acute Care Surgery Fellowship currently at Vanderbilt University, General Surgery Residency 2024 - Loma Linda University

Travis H Smith, MD
General Surgery Resident PGY3, Loyola University Medical Center

Paper compilation/author:
Megan T. Quintana, MD FACS
Assistant Professor of Surgery, George Washington University

The Diversity, Equity, and Inclusion Committee and the Associate Member Council makes it a priority to give a voice to underrepresented medical students, residents, and fellows while promoting diversity and equity within the field of acute care surgery. One way of doing this is through our annual Diversity Essay Contest. Although the winning essay is published in Trauma Surgery & Acute Care Open, we hope to highlight other impactful essays in this issue of the Cutting Edge.

When asked to describe why the trainee wanted to pursue a career in Acute Care Surgery and what impact they wanted to have, Travis H. Smith, MD, a third-year general surgery resident from Loyola University Medical Center, reflected…

Timing, a prevalent theme throughout trauma, often changes the course of a person’s life. While I was on my trauma surgery and ICU rotations as a medical student, I experienced what so many of my patients’ families had gone through - inexplicable loss. A friend fallen victim to a tragic accident. One Texas summer night, [my friend] was walking down the side of the road, and he was hit by car. I honestly couldn’t tell you any other details of the accident. I never asked. I never went looking for them either. I knew what they were. I had seen it several times already in just a few short months. He passed away two days after the accident.

As jarring and horrifying as some of the traumas I had seen were, there always seemed to be healthy emotional distance from the team and the patient. [This situation] broke down that barrier for me. The other side that each family went through no longer felt so far away. The empathy felt much more intense and sat much deeper. I struggled in processing [his] death, and it originally presented as feeling as if I didn’t have the emotional capacity to successfully navigate trauma surgery.

We are uniquely positioned to be present in the worst days of people’s lives. A gift and a burden. We will be there to save someone from impending death, but we will also be there for someone else’s last breath. Each experience ladened with a great burden we will have to carry, but each with the opportunity to find profound beauty. We will inevitably see many last breaths. All will present with the opportunity to show boundless empathy, grace, kindness, and compassion in some of the worst moments.

Before I started medical school, my Dad asked me a poignant question that I had not considered before. He asked, “Are you sure you want to be around so much death and dying?” As the sarcastic kid that talked back a bit too much, my response was “No of course not, but someone has to.” I’d change my answer now. I’d say ‘Yes, I do. I think that is where I can make the biggest impact.” I want to be able to find the smallest bits of light in the darkest of days to help families and patients through their worst moments.

Zachary Tran, MD, a Surgical Critical Care and Acute Care Surgery Fellow at Vanderbilt University and recent graduate from general surgery residency at Loma Linda University, also shared…

One of the most significant moments that led me down the path of pursuing a career in acute care surgery began like many others: at two o’clock in the morning in the middle of a trauma call. My attending and I found ourselves working in [a] poorly equipped operating room. …My attending stated to me, “We’re acute care surgeons. We know how to work in suboptimal conditions.” Little did I know that these words would be a recurrent theme in my motivations to pursue the field.

Later that year at the onset of the COVID-19 pandemic, I rotated through the surgical ICU. The initial threat of COVID was palpable and there was a great deal of uncertainty how much it would impact daily work. As the month progressed, the COVID+ census exploded and elective cases were cancelled. As the medical ICU became overwhelmed with COVID pneumonia patients, the surgical ICU became the prime location for overflow patients. Acute care surgeons were more valuable than ever. In a time of uncertainty and straining of hospital resources, acute care surgeons drove the care of patients at all phases of care. Having the broad training to confidently care for any patient who walked through the door, their value became even more apparent to their communities.

When I moved onto the fourth year of residency, I had the privilege of rotating at a mission hospital in Malawi. In training alongside African-trained surgical residents for two months, I further experienced first-hand what it meant to practice in a resource-limited setting. After a hurricane ravaged the country causing supply chain issues in the hospital, we learned to work with even greater constrained resources. In a hospital system where everything we used was billed directly to the patient, practicing cost-conscious care was paramount for an extremely indigent patient population. For patients that could afford higher levels of care, resources were limited by the medications and laboratory tests that were available to us. There was no available blood gas to titrate the ventilator in a patient who developed sepsis following a leak following esophagectomy. To compound these issues, oxygen tanks were in limited supply and we were faced with decisions to ration care among other desperate patients. During this rotation, I garnered a greater appreciation for the immense resources we take for granted in the United States. In addition, I admired the ingenuity of the surgeons who learned to adapt and overcome daily social, financial, and cultural adversity.

A career in acute care surgery excites me because of the diverse practice settings I will be afforded. From resuscitating a patient in the trauma bay, to leading their perioperative care to ensuring their continued recovery afterwards, acute care surgeons find themselves leaders in all phases of patient care. From the ivory tower medical systems to a hospital in the middle of nowhere in Malawi, the acute care surgeon has training to be useful in any setting. Regardless of the environment, we learn to work within the confines of our surroundings. We’re adaptable and ever-changing. We’re the ones that find comfort in suboptimal conditions. We’re acute care surgeons.

We thank our thoughtful residents and fellows for sharing their reflection, insight, and aspirations. The future of Acute Care Surgery is in capable and compassionate hands.

AAST Associate Membership

AAST Associate Membership Mentorship Scholarship 2023-2024 Report

Mentor: Sharon Henry, MD, FACS, AAST Vice President
Mentee: Sarah Cottrell-Cumber, DO

Introduction: The AAST Associate Membership Mentoring Scholarship was an invaluable opportunity for one-on-one contact with a senior AAST leader. As a chief surgery resident, I am at a pivotal time in identity formation, career development, and leadership skill building. My objectives were to focus on those three topics throughout the year with Dr. Henry. I feel as if I succeeded in these objectives.

Meetings: Meetings were conducted every four to six weeks. We held seven virtual Zoom meetings and one in person meeting at the AAST leadership retreat in April 2024. Meetings typically lasted an hour and covered multiple professional and personal topics.

Highlights:

-Dr. Henry was a guide throughout the entire process of applying to surgical critical care fellowship, interviews, and ultimately a successful Match Day. She helped me reflect on priorities for fellowship: do I want to “think big thoughts” or be clinically busy during my fellowship training? She provided common themes which persisted amongst program selection and ranking. Ultimately, it was Dr. Henry’s questions which changed what I was looking for in my training, in a great direction. Whenever I felt indecisive or unsure of what I wanted, I referenced her very first question to me: “think big thoughts or be clinically busy?”.

-Throughout my year as a chief resident, I found myself struggling or celebrating my identify as a surgeon. I recalled the scenario in which I finally identified as a surgeon. I cannot forget Dr. Henry’s knowing smile across the Zoom screen. She recounted her identity story and this was a bonding moment in her mentorship relationship.

-Dr. Henry and I briefly got to see each other in person at the April 2024 AAST Leadership meeting in Chicago, Illinois. The virtual relationship was strengthened by a visit in person.

- Dr. Henry and I shared a mutual interest in social disparities within trauma care. Not only did I thoroughly enjoy our conversations on this topic, I gained insight into her observations, experiences, and opinions on how we can sustainably improve equity in care. Dr. Henry shared a resource: the BRIC (Bullet Related Injury Course) by Dr. Punch in St. Louis. Not only did she provide a new resource, she shared an invitation to an upcoming symposium in November 2024 to see the clinic and learn the medicine from experts in the field.  This symposium is after the official conclusion our formal mentorship year, and both Dr. Henry and I loved this symposium as a way to continue our relationship into the future.

Conclusions: Receiving this scholarship was truly an honor. Not only did I gain a mentor over the past year, but I gained a lifelong relationship, skills, and thought process. I am truly thankful for the above tangible and intangible skills and experiences Dr. Henry provided me with. Often, what we receive out of mentorship cannot be quantified but the impact is limitless.  

American College of Surgeons and American Association for the Surgery of Trauma International Scholarship report​

Written by: Adenauer Góes Jr MD PhD FACS

I have recently accomplished a 15 days rotation at Ryder Trauma Center, in Miami, under the supervision of Dr. Antônio Marttos.

During my observational experience I had the chance to participate on both day and night shifts, case discussions, morbimortality discussions and to observe trauma surgical cases.

Also had the opportunity to see how the trauma team interacts with other specialties such as orthopedics, neurosurgery, vascular surgery and radiology.

I requested for watching academic experiences and I was able to join lectures to medical students given by Dr. Marttos and surgical technique sessions provided to residents by Dr. Carter.

I should also make special acknowledgments regarding Drs. Julie Valenzuela and Gabriel Ruiz, that provided me very interesting opportunities to engage in case discussions.

This international opportunity gave me ideas for research projects and implementations to be made at the institutions I work at.  

In summary, the rotation provided me both surgical and academic opportunities and exceeded my expectations and I would like to take this opportunity not only to thank the committee that selected me for this International Scholarship but also to encourage all the collogues that can to apply for an opportunity like this if they have the chance. 

Showcasing AAST Scholarship Recipients' Impact in Surgical Research

Name: Julia Coleman MD, MPH

Institution: The Ohio State University College of Medicine, Department of Surgery

Title: The Interaction of Estradiol and Platelet Biology: A Mechanistic Exploration of Sex Dimorphisms in Coagulation and Implications for Transfusion Medicine

Kind of funding applied/received: $50,000 research scholarship from AAST allowed Dr. Coleman to hire a full time lab technician as well as acquire appropriate lab equipment to allow for proper testing, experimentation, and data collection. This data generated allowed for Dr. Coleman to submit K08 and K12 grant applications with the NIH.

Timeframe/Status: published 15 articles in last year, two of which selected as Best Paper in Basic Science in Journal of Trauma

Name: Anaar Siletz, MD, PhD

Institution: Keck School of Medicine of USC, Los Angeles General Medical Center

Title: Progress Report: Whole Transcriptome Dynamics in Human Neutrophils After Blunt Trauma

Kind of funding applied/received: A competitive internal grant and R21 funding from the NIH allows Dr Siletz to be able to continue research, trials, and study. Thanks to the AAST Scholarship, Dr. Siletz and team were able to kickstart this project as well as set the stage for further grant awards in just over a year.

Timeframe/Status: These preliminary results are promising and ongoing, and the next steps are intently analyzing data and trial results.

Name: Marissa Boeck, MD, MPH

Institution: UCSF Department of Surgery

Title: Identifying and Addressing Unmet Needs of Injury Survivors at a Safety Net Hospital in San Francisco

Kind of funding applied/received: AAST Scholarship paved the way for Dr. Boeck and team to hire research assistants, select a community member to the research team, hire a clinical research coordinator, acquire necessary materials and instruments, as well as translate study documents into Spanish and Cantonese to best serve the patient population. Dr. Boeck also received aid from the 2024 NIMHD Health Disparities Research Institute.

Timeframe/Status: Receiving initial funding a year ago, Dr. Boeck’s research is ongoing with the third and final implementation phase occurring in July 2025 by way of a UCSF KL2 award. Furthermore, ZSFG Division funding will help measure long term patient outcomes.

Name: Letitia Bible, MD

Institution: University of Florida

Title: Can the gut save the brain? An investigation of microbiome on the recovery from traumatic brain injury.

Kind of funding applied/received: The AAST Scholarship grant allowed begin research in earnest, engaging in initial research with laboratory animals. Preliminary results are unexpected but invaluable, and Dr. Bible is taking this opportunity to further develop leadership and grant writing skills for the next stage of the project.

Timeframe/Status: The next steps are to slightly change the methodology in testing, allowing for more consistent and reliable results and analysis. Dr. Bible is also submitting for a K08 grant from NINDS

Name: John C Kubasiak, MD

Institution: Loyola University of Chicago Department of Surgery, Loyola University Medical Center

Title: Prognostication of Host Immune Response to Trauma Via Characterization of the Hematopoietic Stem Cell/Multipotent Progenitor Cell Axis

Kind of funding applied/received: Initial funding by the AAST Scholarship has resulted in seven presentations at national and international meetings, four published manuscripts with others under review, and those results lead to further funding to continue the work. Dr. Kubasiak and his team received institutional funding, applied for foundational grants, secured a DOD grant, and recently obtained a scored MIRA award by way of GMS.

Timeframe/Status: Project is ongoing, and none of this would be possible without Dr. Kubasiak’s research team, mentors, family, and the AAST for its initial scholarship and continued support.