NIH awards two grants to emergency physicians

NIH awards two grants to emergency physicians


The Department of Emergency Medicine at UC Davis Health has received two National Institutes of Health (NIH) grants totaling more than $5 million to improve emergency patient care.

The first grant will support a study on the use of ultrasound in the assessment of pediatric trauma patients. The second grant will establish a new “hub” site within the SIREN (Strategies to Innovate EmeRgENcy Care Clinical Trials) network. The aim is to identify effective treatments given in the early stages of emergency care.

“It is an incredible honor for our emergency department to receive these two grants, which will help fuel innovation to improve the health of critically ill and injured patients in our community,” said Kim Barrett, Associate Dean for research at UC Davis School of Medicine. “The NIH funds some of our most exciting research and enables us to make groundbreaking advances in treating patients.”

Use of ultrasound in pediatric traumatology

The first grant was awarded to co-principal investigators Nathan Kuppermann, chairman of the Department of Emergency Medicine, and James Holmes, executive vice chairman of the Department of Emergency Medicine, to perform a randomized, controlled trial to compare rates abdominal computed tomography (CT) scans of children looking for suspected intra-abdominal lesions when they receive or do not receive an ultrasound during evaluation in the emergency department.

According to the Centers for Disease Control and Prevention, trauma is the leading cause of death among children in the United States. Among pediatric traumatic deaths, trauma to the torso (intra-abdominal lesions) accounts for 30% of cases.

Currently, a CT scan is the standard for diagnosing intra-abdominal injuries. However, the procedure is associated with radiation-inducing malignancies, or cancer, at an estimated rate of one in 500 abdominal CT scans in children under five. In adolescents, the figure is one per 600 scans.

Due to this risk, ultrasound has evolved as a diagnostic test for the evaluation of intra-abdominal lesions, however, it has been used primarily in adults. The standard abdominal ultrasound for trauma is called the Focused Assessment Sonography for Trauma (FAST) exam. The advantages of the FAST exam (compared to CT) include:

  • bedside availability during emergency department assessment
  • quick completion (3-5 minutes)
  • possibility of repeating the exams
  • lack of radiation exposure

“Some studies with adult trauma patients have shown that implementing an emergency department assessment strategy that includes a FAST exam improves clinical outcomes, reduces complications and length of hospital stay, the use of abdominal CT scans and hospital costs,” Kuppermann explained. “However, due to the lack of definitive evidence from studies, FAST exams are less commonly used in emergency department assessments of children with abdominal trauma.”

For this study, Kuppermann and Holmes plan to conduct a multicenter, randomized, controlled trial of the FAST exam during the initial emergency department evaluation of children with blunt abdominal trauma. They will measure the use of abdominal CT scans and the rate of missed intra-abdominal injury, which will be defined by an intra-abdominal injury diagnosed after an assessment in the emergency department. Secondary outcomes will include ED length of stay and hospitalization rate.

“Although the sensitivity of the FAST exam for intra-abdominal injuries is lower than that of a CT scan, as a screening test it may reduce the need for abdominal CT scans in children,” Holmes said. “This will reduce the use of abdominal CT scans and increase patient safety by decreasing the risk of radiation-induced malignancies.”

New “hub” in the SIREN network

A multidisciplinary team of physicians from UC Davis Health, Stanford, and UC San Francisco has received a grant to make the Northern California Acute Care Research Consortium (NORCARES) a new SIREN Hub.

The Strategies to Innovate EmeRgENcy Care (SIREN) Clinical Trials Network is a clinical trial network funded by the National Institutes of Health, with the goal of improving outcomes for patients with neurological, cardiac, respiratory, and hematological emergencies by identifying effective treatments administered in the early stages of treatment.

“These three institutions are well placed to lead a new SIREN center, having demonstrated broad and sustained growth in their research programs and productivity over the past 20 years with a robust research infrastructure to facilitate patient recruitment in the trials,” said Daniel Nishijima, vice chair of research in the Department of Emergency Medicine and co-principal investigator for the grant. “With a strong infrastructure and an innovative collaboration plan, our Hub is uniquely positioned to drive recruitment and promote equity and diversity of patient populations in SIREN trials.”

The NORCARES Hub will partner with and provide clinical trial support to more than 30 hospitals and EMS agencies (spokes) in Northern California and the Western Region, leveraging large and diverse patient volumes, urban and rural geographies and academic and community hospitals.

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