The third annual COT Military Region Excelsior Society meeting was held in conjunction with the American College of Surgeons Annual Clinical Congress in San Diego, CA. The AVAS was the proud sponsor of three papers (out of a total of eleven) presented at the annual COT Resident Trauma competition. These three abstracts were the winners of the AVAS Region 13-VA COT competition held during its annual meeting in May, 2017 in Houston, TX.
Charles A. Karcutskie, MD, MA (PGY-5, General Surgery Resident Jackson Memorial Hospital, University of Miami) was a guest presenter as his paper had already been accepted and published in JAMA surgery. Their study, “DOES ANTIFACTOR-XA GUIDED DOSING OF ENOXAPARIN DECREASE THE VENOUS THROMBOEMBOLISM RATE IN TRAUMA PATIENT” examined standard fixed dose vs dose adjusted enoxaparin with antifactor-Xa levels for the use of thromboprophylaxis after trauma. In this study of 216 patients, the authors reported that there was no reduction in the incidence of venous thromboembolism (VTE) with the use of anti factor-Xa guided dosing of enoxaparin.
Furthermore, almost half of the patients were unable to reach prophylactic anti factor-Xa levels with increased enoxaparin dosing, and those that did, did not have a lower VTE rate. This provided evidence that optimal thromboprophylaxis may need to extend beyond coagulation factor inhibition, such as through the use of targeted platelet inhibition.
Dr. Tyler Evans, MD (resident at the Roudebush VAMC, Indiana University, Indianapolis, IN) first presented his basic science paper “DOWN-REGULATION ACCELERATES BONE REGENERATION IN THE ABSENCE OF ANY OTHER TREATMENT”. He explained that while Prevention of traumatic injuries is essential, the future may bring new methods to heal bony defects through targeted antibody or gene therapy. Their study examined Sclerostin (a glycoprotein involved in bone formation/maintenance through the WNT signaling pathway) down-regulation. By down-regulating sclerostin, they hypothesized this would lead to non-weight bearing bone regeneration in a mouse model. The model used sclerostin knockout mice vs control wild type mice with calvarial bone defects. The results showed knockout mice were able to regenerate 40% of the initial critical size defect at 8 weeks, compared to only 10% in wild type. A statistically significant increase in bone density was also shown. By blocking sclerostin, it was not able to down-regulate WNT pathway, ultimately leading to increased bone formation. Monoclonal antibodies have already been in clinical trials for use in osteoporosis, and manipulation of this pathway may also prove to be effective in healing traumatic bone defects.
Dr. Evans next presented his clinical trauma paper on their study “DO DRIVERS OR PASSENGERS GET HIT HARDER: A COMPARISON OF NEUROLOGIC TRAUMA AND MOTORCYCLE HELMET USE”.
This study was designed to investigate neurologic and head/neck injuries from motorcycle accidents and to compare the value of helmet use between passengers and drivers. Interestingly, the neuroprotective benefit of helmets appeared to be more significant for drivers, although helmets did reduce rates of traumatic brain injury and head/neck injury for passengers and drivers. Glasgow Coma Scale averages were also higher in both groups when wearing helmets. Overall, the study showed low rates of helmet use amongst drivers and passengers, with passengers being least likely to wear helmets in all demographics. This study should serve as a call for universal helmet laws and special intervention to promote helmet use to protect against devastating head/neck injuries, with emphasis on those least compliant with this safety measure.
The AVAS annual meeting provides a venue for residents to present papers covering the topics of Trauma, Critical Care, and Acute Care Surgery. Those residents who are not already engaged in the ACS-COT resident Trauma competition in one of our military partner organizational meetings are eligible to compete to represent the VA at the annual ACS-COT Military Region 13 competition. The winners of the regional competition are then sent to the annual COT meeting to participate in the national competition. All residents are encouraged to present papers at the annual AVAS meeting.