Trauma Research
Under the leadership of Victor F. Garcia, MD, Director of Trauma Services at Cincinnati Children's Hospital Medical Center, a variety of injury control and research studies are being conducted:
Home Safe Home Program
This multifaceted program is being conducted in partnership with Every Child Succeeds. The program focuses on increasing the use of effective injury prevention devices and behaviors among mothers of infants and toddlers, with the long-term goal of significantly reducing the number of injury-related hospitalizations and deaths among this cohort of children. The program comprises injury prevention education for home visitors, injury prevention education for mothers (conducted by home visitors), and child passenger safety.
The program focuses on those in our community who most need support. In particular, our efforts focus on reaching the minority African American and Hispanic population that are disproportionately affected by such injuries.
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Youth Injury Prevention (YIP) - African American
This innovative and highly successful community based injury prevention initiative was developed as a partnership between Trauma Services and the African American faith community. Through this partnership we have been able to educate families on fire and gun safety, home safety, drowning prevention, pedestrian safety and most importantly motor vehicle safety and the proper use of child restraints. This program has been remarkably successful in increasing proper seating position and restraint use among African American children and additionally has increased restraint use among adults as well. This program has been recognized nationally by the NHTSA and regionally by the Ohio Department of Public Safety who plan to use our YIP model for promoting car safety statewide.
We are currently working to expand our program and develop a packaged curriculum that can be distributed nationally.
Youth Injury Prevention – Hispanic
Given the growing number of Hispanic children in our community and their disproportionate injury numbers we have partnered with Toyota to develop a Youth Injury Prevention program that is culturally sensitive for the Hispanic community. Building upon the success of our African American program, we have partnered with the Hispanic faith community to develop a safety curriculum and program implemented through the churches. In its early stages, this program has been well received and we are collecting data to determine the success in improving safe behaviors.
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Reducing Injury Among High Risk Preschool Children
This federally funded study is designed to reduce the risk of injury among preschool children. We are achieving this goal by (1) increasing awareness of the risks of pediatric injury among preschool children, parents, and teachers participating in the Head Start program, (2) by identifying barriers to the use of injury prevention devices, and (3) by increasing the use of such devices.
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School Re-Entry
This program addresses the special cognitive, physical and emotional needs of injured children returning to the classroom after hospitalization. Our goal is to facilitate smooth and successful re-entry into the school environs and to utilize the "teachable moment" to promote injury prevention among classmates and friends. This education has been shown to improve knowledge in classmates which is retained on follow up testing. Future studies will examine the ability to expand this program by training teachers and other injury prevention specialists to facilitate school re-entry and educate children on injury prevention.
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Quality of Life Following Traumatic Injury
We have identified a significant impact on Quality of Life for both patients and their families following traumatic injury. Ongoing research will continue to expand upon our understanding of specific factors affecting quality of life and developing specific family and patient centered approaches to minimize this effect.
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Intelligent Patient Monitoring System
Victor F. Garcia, MD and Rebeccah L. Brown, MD
In collaboration with scientists from Qualia Computing Inc and physicians in Cincinnati Children's Division of Emergency Medicine and Cardiac Care Unit, we are developing a novel patient monitor that is based on the application of cognitive systems technologies. The monitor is capable of assessing the more meaningful and earlier non-linear responses of the body to major blood loss. The prototype of the Intelligent Patient Monitor detected the early phases of hemorrhage-related circulatory dysfunction prior to the onset of hypotension or changes in heart rate. The final product will change the paradigm for the treatment of shock and will have an immediate and direct impact on the care of the seriously injured patient.
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Understanding the Epidemiology of Injury Related Health Disparities
Despite advances in injury prevention and care of the injured child, minority children continue to be disproportionately affected as the result of preventable injuries. The causes of such disparities are likely multifactorial but remain unclear. Using our comprehensive trauma database system we are investigating these disparities to better understand the causes. As we better understand this complex problem, we will be able to develop specific interventions designed to reduce the inequities.
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Clinical Effectiveness and Practice Guidelines
Victor F. Garcia, MD
We participate in this statewide study of the effectiveness of practice guidelines in managing children with hepatic and splenic injuries.
Development of Evidence-Based Guidelines in the Care of Pediatric Head Injury
Pediatric head injury is a leading cause of death and long-term morbidity. In collaboration with pediatric neurosurgery as well as pediatric critical care and rehabilitation medicine we are working to develop guidelines and systems to maximize care of these injured children. In particular, we are interested in the management of elevated intracranial pressures in children with severe head injury. We are currently developing a prospective randomized study to evaluate the effectiveness and appropriate administration of hypertonic saline.
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Multidisciplinary Trauma Education Utilizing a Human Patient Simulator
Management of pediatric trauma is complex and requires a multidisciplinary team including trauma surgeons, emergency medicine physicians, fellows and residents, nurses and respiratory therapists. In order to provide the highest level of care, this care group must work efficiently as a team and utilize a "shared mental model". In order to maximize continued education in the care of the injured child we have begun utilizing a high fidelity human patient simulator. Through this education we intend to be able to demonstrate improved teamwork and leadership among team members, more rapid recognition and management of injuries, and, ultimately, improved outcomes for severely injured children.
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