My goal in seeking a K01 Award is to acquire the necessary training to become an independently funded investigator focused on exploiting the power of biomedical Big Data Science to improve outcome following severe injury. I am a trauma surgeon at San Francisco General Hospital, one of the Nation's leading trauma centers, and an Assistant Professor of Surgery at the University of California San Francisco (UCSF). UCSF has recently entered into collaboration with the National Laboratories to study the use of biomedical Big Data in complex clinical conditions and my main mentor, Dr. Mitchell J. Cohen is the lead investigator at UCSF for this collaboration. I believe that given the complexity of the factors that likely affect traum outcome including patient injury patterns, medical co-morbidities, patient biology, and the system of care, trauma provides a solid foundation to study the utility of Big Data Science for solving complex medical questions. To facilitate my growth as an expert in this field, I am proposing to develop a framework for integrating multiple data sources necessary to forecast patient outcomes following trauma. These novel datasets combined with biologic and metadata will then be utilized to create improved metrics that better predict complication risk from modifiable and non-modifiable factors. The net result of this work is a new approach to data ascertainment for measuring outcome, leveraging new data types to improve prediction of patient trajectory, and creating a platform to interface with existing information technology to ultimately be used for an early warning detection system for patients at risk of complications. The future long-term goal of this work would be to identify early patients predicted to do more poorly and then apply refinements to the process of care to minimize complication development. The creation of early warning detection systems has significant theoretic potential to improve quality and ultimately decrease costs. Nearly $30 billion per year in the US is spent on care for the traumatically injured and the development of post-traumatic complications is believed to be major contributor to the overall costs of care. The ability to report performance has been hampered by a lack of standard definitions, reporting bias, access to datasets, and the analysis techniques that fail to account for the highly confounded relationships contributing to patient outcome. This K01 award will provide me with the support necessary to accomplish the following goals: (1) to become an expert in applying biologic big data to trauma care (2) to elucidate the relationship of modifiable factors affecting complication development (3) to gain experience with advanced biostatistical techniques and bioinformatics; and (4) to develop an independent clinical research career. To achieve these goals, I have assembled a multidisciplinary team including Dr. Cohen, a National expert in trauma systems biology and biologic big data, and two co-mentors: Dr. Michael Matthay, a translational research expert in complications after severe illness, and Dr. Alan Hubbard, an expert in advanced biostatistical techniques including biologic big data analysis.

Public Health Relevance

In the US, trauma is the leading cause of death for those under 45 years old and many of the patients who survive their initial injuries develop complications such as blood clots or pneumonia that contribute to both death and the long-term effects of the trauma. Through leveraging the power of biomedical Big Data, an integrated approach to measuring outcome will be developed utilizing biologic, clinical, and electronic medical record (EMR) data. The goal of this project is to lay the ground work for developing integrated EMR early warning detection systems that could identify those at risk of complications early with the intent to ultimately refie the process of care for this group to minimize complication development.

Agency
National Institute of Health (NIH)
Institute
National Institute of Environmental Health Sciences (NIEHS)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01ES026834-04
Application #
9530647
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Shreffler, Carol A
Project Start
2015-09-30
Project End
2019-07-31
Budget Start
2018-08-01
Budget End
2019-07-31
Support Year
4
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Surgery
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94118
Stettler, Gregory R; Sumislawski, Joshua J; Moore, Ernest E et al. (2018) Citrated kaolin thrombelastography (TEG) thresholds for goal-directed therapy in injured patients receiving massive transfusion. J Trauma Acute Care Surg 85:734-740
Kornblith, Lucy Z; Robles, Anamaria J; Conroy, Amanda S et al. (2018) Perhaps it's not the platelet: Ristocetin uncovers the potential role of von Willebrand factor in impaired platelet aggregation following traumatic brain injury. J Trauma Acute Care Surg 85:873-880
Christie, S Ariane; Hubbard, Alan E; Callcut, Rachael A et al. (2018) Machine learning without borders? An adaptable tool to optimize mortality prediction in diverse clinical settings. J Trauma Acute Care Surg 85:921-927
Howard, Benjamin Michael; Kornblith, Lucy Z; Redick, Brittney J et al. (2018) Exposing the bidirectional effects of alcohol on coagulation in trauma: Impaired clot formation and decreased fibrinolysis in rotational thromboelastometry. J Trauma Acute Care Surg 84:97-103
Ferrada, Paula; Callcut, Rachael A; Skarupa, David J et al. (2018) Circulation first - the time has come to question the sequencing of care in the ABCs of trauma; an American Association for the Surgery of Trauma multicenter trial. World J Emerg Surg 13:8
Robles, Anamaria J; Kornblith, Lucy Z; Hendrickson, Carolyn M et al. (2018) Health Care Utilization and the Cost of Post-Traumatic ARDS Care. J Trauma Acute Care Surg :
Robinson, Bryce R H; Cohen, Mitchell J; Holcomb, John B et al. (2018) Risk Factors for the Development of Acute Respiratory Distress Syndrome Following Hemorrhage. Shock 50:258-264
Robles, Anamaria J; Kornblith, Lucy Z; Hendrickson, Carolyn M et al. (2018) Health care utilization and the cost of posttraumatic acute respiratory distress syndrome care. J Trauma Acute Care Surg 85:148-154
Kunitake, Ryan C; Kornblith, Lucy Z; Cohen, Mitchell Jay et al. (2018) Trauma Early Mortality Prediction Tool (TEMPT) for assessing 28-day mortality. Trauma Surg Acute Care Open 3:e000131
Plevin, Rebecca; Callcut, Rachael (2017) Update in sepsis guidelines: what is really new? Trauma Surg Acute Care Open 2:e000088

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