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The institution's principal publication for alumni, friends and physicians.
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  F E A T U R E S  
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  Multidisciplinary Research Drives Better Care  
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  Sharing Trauma Expertise  
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FEATURES
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MULTIDISCIPLINARY RESEARCH DRIVES IMPROVEMENTS IN TRAUMA CARE

UC Davis is the only trauma center in the region that conducts research on a regular basis.

"" PHOTO — Trauma surgeon Jason London discusses a case with the rest of the trauma team which includes physicians, trauma nurse practitioners, nurses and others. London is one of 10 trauma surgeons who provides a wide range of acute care at the region's only Level 1 adult and pediatric trauma program
 
Trauma surgeon Jason London discusses a case with the rest of the trauma team which includes physicians, trauma nurse practitioners, nurses and others. London is one of 10 trauma surgeons who provides a wide range of acute care at the region's only Level 1 adult and pediatric trauma program.
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Incremental and painstaking, medical research has been called the slow road to miracles. But in one discipline – trauma care – the theoretical must become practical at lightning speed.

With injuries that can compound in seconds, trauma is the leading cause of death and disability for people younger than 45 years of age, and "the single-most important cause of loss of years of productive life," says UC Davis Health System trauma surgeon Garth Utter. "Research into prevention and treatment of injury is a vital public good, because injury can strike anybody anywhere, at any time."

Serving 33 Northern California counties and 6 million residents as the only trauma center granted Level 1 status by the American College of Surgeons, the UC Davis trauma team cares for more than 7,000 patients each year, half of whom are admitted to the hospital.

Moreover, "UC Davis is the only trauma center in the region that conducts research on a regular basis," says UC Davis trauma surgeon Jason London.

London says the realm of research goes far beyond surgery studies. Researchers who specialize in burns, traumatic emergencies, bone fractures, neurological disorders, childhood illness, disease pathology and numerous other disciplines make trauma research at UC Davis one of the medical center's most interdisciplinary and robust research pursuits.

Restoring lives

The UC Davis orthopaedic trauma group is a case in point – physicians "who manage high-volume clinical practices while orchestrating multiple research projects," explains orthopaedist Mark Lee, who directs his department's trauma fellowship.

Lee says the orthopaedic research team is developing methods that will "change the way community surgeons think about repairing fractures," such as the use of specially engineered proteins to heal bone and new techniques that allow surgeons to fix bones through smaller incisions with better stability.

"Every day we see people and families who have just had the worst experience of their lives, and one of their first questions to us is whether or not they will walk again, work again, or play with their kids again," Lee explains. "There are few things in life more rewarding than seeing the relief on their faces when you assure them that there is hope and that there is a way."

The trauma detective

When a community-hospital physician recently ordered a computerized tomography (CT) scan for an infant facing possible brain injury, he based his decision on rules UC Davis emergency physicians Nathan Kuppermann and James Holmes helped develop.

"Thinking there was no way the child would have a traumatic brain injury, my colleague was nearly ready to send him home with his parents," Holmes says. But after the CT scan showed internal bleeding in the infant's head, the physician transferred the boy to a pediatric intensive care unit.

"This is the goal of our work," Holmes explains. "To ensure that injuries are identified immediately."

PHOTO — UC Davis pediatric emergency specialist Nathan Kuppermann seeks through his research to advance the prevention and management of acute childhood illnesses and injuries. ""

UC Davis pediatric emergency specialist Nathan Kuppermann seeks through his research to advance the prevention and management of acute childhood illnesses and injuries.
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An expert in abdominal trauma and imaging, Holmes is developing what he calls "highly sensitive decision rules for the observation and evaluation of children with blunt abdominal trauma." He has already received funding from the Center for Disease Control for the project.

While an excellent diagnostic tool, CT scans carry risks related to the substantial radiation used for imaging. Holmes hopes the new decision rules for abdominal CT imaging in the setting of trauma will "result in the timely identification of children in need of acute intervention, while decreasing unnecessary CT use."

UC Davis will be a leading participant in this newest abdominal CT study. Holmes, Kuppermann and other researchers will observe over 10,000 children with blunt abdominal trauma at 16 hospitals that are members of the Pediatric Emergency Care Applied Research Network (PECARN), the nation's first federally funded pediatric emergency medicine research cooperative.

A collaborative co-op

Collaboration is a hallmark of UC Davis pediatric emergency specialist Nathan Kuppermann's work.

As the principal investigator on a federally funded PECARN pediatric traumatic brain injury study that recently finished collecting data on 44,000 children with head trauma, Kuppermann teamed up with Holmes. With his wife, UC Davis pediatrician Nicole Glaser, Kuppermann published an important study in the New England Journal of Medicine on the prediction of complications of Type 1 diabetes in children.

He also recently developed a simple algorithm with colleagues at Children's Hospital Boston that can help doctors rapidly distinguish infants and children with viral meningitis from those with bacterial meningitis – potentially reducing unnecessary hospital admissions and prolonged antibiotic treatment. His findings were published in the Journal of the American Medical Association in January.

As chair and research director of UC Davis' Department of Emergency Medicine, Kuppermann continues a tradition of science, collaboration and advocacy that resulted in the creation of PECARN.

Seeking a better way to advance the prevention and management of acute childhood illnesses and injuries, Kuppermann helped to found PECARN as a way to link institutions nationwide in a large cooperative research network.

Seeking a better way to advance the prevention and management of acute childhood illnesses and injuries, Kuppermann helped to found PECARN as a way to link institutions nationwide in a large cooperative research network.

As chair of PECARN's steering committee since its inception in 2001, Kuppermann helps guide four research nodes at more than 20 hospital emergency departments that serve approximately 800,000 ill and injured children every year.

He's especially interested in establishing clinical decision rules that can help physicians in any hospital, under any circumstances, make correct emergency treatment choices in the care of acutely ill and injured children, particularly when there is little time to make decisions.

"It's correct to describe what we are seeking in our decision rules as a 'triple play'," Kuppermann explains. "With the right set of decision rules – say on when to use CT scanning for head trauma – we can correctly and expeditiously identify patients in need of CT scanning, conserve resources and reduce dangerous side effects."

A teammate for life

As a member of Team Donate Life's Race Across America, Felix Battistella has bicycled 3,000 miles to raise money for transplant research at UC Davis. Battistella likes to "push himself," he says. "Hard."

Saving lives may be the greatest race of all, and as UC Davis' chief of trauma surgery, Battistella isn't just racing faster – he's racing smarter.

Studying ways to wean trauma patients from mechanical ventilators that breathe for them, Battistella also helped formulate a management protocol that restores people to breathing on their own while decreasing pneumonia risk.

"My research has focused on the experience we have developed treating a large volume of trauma patients here in Sacramento, but the findings are applicable to trauma patients throughout the country," Battistella says.

The best time to perform an operation on patients with severe liver damage is one of Battistella's findings that has been embraced in many trauma centers.

Severe liver damage often requires multiple operations. Battistella and his research team "determined that there was an ideal time for the second operation."

Performed too soon, second operations on liver injury can cause the patient to bleed too much. Performed too late, the risk of infection increases. But "between 36 and 72 hours after the first operation," the second operation can be a lifesaver.

That is exactly how one patient's family chose to commemorate Battistella's care – with Life Savers candy.

"I was not sure the patient would survive," he explains. "After surgery, I met with the her family, including her 10-year-old daughter, to relay the grave prognosis."

Ultimately, the patient improved and returned home.

"Her daughter gave me a roll of Life Savers," Battistella says, as sweet thanks for saving her mom.

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  Research into prevention and treatment of injury is a vital public good, because injury can strike anybody anywhere, at any time.

— Trauma surgeon,
Garth Utter  
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