In 2003 there were 114 million emergency department visits, of which 5.7 percent involved the treatment of acute open wounds. In general there is a lack of clinical outcomes research to determine the most efficient method to treat these wounds. Current treatment of acute wounds is guided by old dogma, some of which may not be appropriate. Evidence is based on animal trials and on old clinical research lacking sufficient methods or in fact non-existent and perpetuated by opinion. A classic example is the treatment of hand lacerations and the rate of wound infections from dog bites, both studied in the candidate's K-23 award. Old literature suggests the baseline infection rates for dog bites is about 15 percent overall and perhaps as high as 30 percent for hand wounds leading to many advocating for prophylactic antibiotics. Current work suggests that the current rate of infection is probably 5 percent making the rationale to treat all wounds invalid. The candidate has also challenged dogma demonstrating that simple hand lacerations heal regardless of whether they are treated with sutures or conservatively. The majority of acute wounds are simple and uncomplicated that only occasionally may develop complications such as infection and dehiscence. There are tremendous variations in wound care practices among physicians. This includes wound cleansing (what solution and how much irrigation?), wound closure (primary vs. secondary and modality), and the use of prophylactic antibiotics. Determining which wounds are at risk for complications based on outcomes research will guide treatment and follow-up decisions and ultimately allow for the most cost-effective care. The candidate has expertise in the area of wound care and has completed extra graduate training in clinical research. Having successfully completed his K-23 award the candidate has prepared himself for a career as an independent clinical scientist .The purpose of the proposed application is to allow the candidate to utilize his research skills in clinical decision rule development and his passion for wound care research to develop clinical decision guidelines to predict wounds at risk for complications after ED treatment.
The specific aim of this application is to utilize the wound care network established in the candidate's K-23 to collect a large prospective cohort of lacerations and acute dog bite wounds to develop a decision rule to predict wound healing complications. Using his real-time notification and tracking system to identify eligible patients, he will have physicians prospectively complete a standardized web based data collection form. He will then determine wound outcomes (infection and dehiscence) within 30 days to determine the rates of acute wound complications. Using his skills in clinical prediction rule development specifically utilizing recursive partitioning techniques he will derive highly sensitive and specific clinical prediction rules for predicting complications of acute lacerations and dog bite wounds. If the candidate can successfully derive the rules in this R-21 they will be subsequently validated and implemented to improve the efficiency of acute wound care. ? ? This application will study the second most common reason why people seek medical care in the country, the treatment of acute traumatic lacerations and bites. The potential impact of this study is enormous as the study results will guide efficient and cost effective management decisions on controversial issues such as which patients would benefit from prophylactic antibiotics. This will be accomplished by studying a large group of patients presenting to emergency departments with acute lacerations and dog bites to determine the current incidence of wound complications, primarily infection. Numerous variables will then be analyzed to determine a group of risk factors for developing these complications. Knowing which patients are at risk for complications will help guide treatment and management decisions. ? ? ?
| Tabaka, Meg E; Quinn, James V; Kohn, Michael A et al. (2015) Predictors of infection from dog bite wounds: which patients may benefit from prophylactic antibiotics? Emerg Med J 32:860-3 |
| Quinn, James V; Polevoi, Steven K; Kohn, Michael A (2014) Traumatic lacerations: what are the risks for infection and has the 'golden period' of laceration care disappeared? Emerg Med J 31:96-100 |
