UTHealth researchers have received a grant from the National Heart, Lung, and Blood Institute (NHLBI) and will collaborate with colleagues at The University of Texas MD Anderson Cancer Center to help accelerate the recognition and treatment of life-threatening hemorrhage in trauma patients.
Injury is the number one cause of death for people ages one to 44. For the injured receiving medical attention, there is no reliable sign or diagnostic test immediately available to gauge bleeding severity or the amount of donor blood needed.
“Blood products are a precious resource and transfusion poses risks. Rapid recognition of bleeding and prudent use of blood products are both imperative,” said Mohammad Hossein Rahbar, PhD, principal investigator and director of the Division of Clinical and Translational Sciences in the Department of Internal Medicine at UTHealth Medical School and director of the Biostatistics, Epidemiology, and Research Design (BERD) component of the Center for Clinical and Translational Sciences at UTHealth.
The two-year, $420,000 grant (1R21HL 109479-01A1) from NHLBI, part of the National Institutes of Health, will enable researchers to develop statistical models to help identify trauma patients at high risk of lethal hemorrhage as early as possible.
“This new project will harness the power of innovative statistical methodology in the hands of experienced investigators for the analysis of high-quality data,” Rahbar said. The model will use detailed, minute-to-minute patient data available from the groundbreaking Prospective, Observational, Multi-center Major Trauma Transfusion (PROMMTT) study.
“PROMMTT was the first multi-center prospective observational study ever performed in bleeding trauma patients. This type of patient has a 25 percent mortality rate,” said co-investigator John Holcomb, MD, director of the Center for Translational Injury Research at UTHealth and director of the Texas Trauma Institute at Memorial Hermann-Texas Medical Center. PROMMTT began in 2008 at ten major trauma centers, including Memorial Hermann-Texas Medical Center.
Rahbar and his team are pursuing statistical models that can identify high-risk patients more promptly and accurately than the conventional approach. Receiving 10 or more units of red blood cells within 24 hours, or “massive transfusion”, is the conventional way patients with severe bleeding are identified.
“Using massive transfusion in place of patients’ actual bleeding severity has biased a great deal of published research including randomized trials. Among other problems, patients unable to survive hemorrhage long enough to receive 10 units of transfusions are misclassified as low-risk survivors. With the vast majority of trauma deaths occurring in the minutes or hours following injury and the response capabilities of trauma systems steadily improving, we really need a better measure,” said Deborah del Junco, PhD, co-investigator and director of outcomes research at the Center for Translational Injury Research and senior epidemiologist in the Division of Clinical and Translational Sciences at UTHealth.
“Our approach is innovative because for the first time, it introduces latent class models to blood transfusion research,” said Rahbar, who also holds a faculty appointment at UTHealth School of Public Health.
The study will bring important new insights to trauma and transfusion research as well as clinical practice. “Our approach is significant because it brings the latest statistical methodology to the forefront of blood transfusion research. It will address the critical questions of how to accurately identify patients in need of a massive transfusion protocol and how to analyze the time-dependent transfusion process.” said Jing Ning, PhD, assistant professor of biostatistics at MD Anderson and the study’s principal investigator.
The project is called “Statistical Methodology Development in Blood Transfusion Protocol Research.” Additional co-investigators from UTHealth include Sangbum Choi, PhD and Erin Fox, PhD.