The University of Texas at Tyler received $100,000 from UT System’s Trauma Research and Combat Casualty Care Collaborative to help improve the lives of patients with Traumatic Brain Injury, or TBI. Dr. Shawana Tabassum serves as the project’s principal investigator. (Contributed Photo)

UT Tyler researchers aim to help improve trauma care with grants from the Texas Legislature.

As part of the Texas Legislature’s efforts to improve trauma care in Texas, the University of Texas System received $20 million in funding from TRC4, Trauma Research and Combat Casualty Care Collaboration. Through representatives from the UT System, they set up a competitive grant process.

Three UT Tyler researchers received grants for research in different areas of trauma care. The grant provides funding not often available for trauma research. Because there is no institute for trauma or injury research at the National Institutes of Health, most of the funding comes from the United States Department of Defense.

“This is an important and very much appreciated contribution from the state legislature to help us to improve our outcomes for injured Texans,” said Dr. Alan Cook, Medical Director at the UT Tyler Center for Clinical Research.

A collaboration with AI

In collaboration with UT San Antonio and UT Tyler, researchers will work together as part of a $1 million grant to develop and apply artificial intelligence (AI) tools to the field of trauma care.

There are three principal investigators handling three separate areas. Dr. Brian Eastridge is organizing the project; Cook will be in charge of the research; and Dr. Amina Qutub, from UT San Antonio, is behind the AI component.

Over the last 20 years, there have been innovations and improvements in trauma care thanks to the development of databases focused on the outcome of patients once they reach the trauma center. The National Trauma Data Bank captures data from the emergency department, through hospitalization and hospital discharge. However, data for pre-hospital settings are not as readily available.

“That means from the instant the traumatic injury occurs until arrival at the hospital, we don’t have as clear a picture of events that take place,” Cook said. “How long things take, how far someone is from the Level 1 or Level 2 trauma center that can provide definitive care for their injury. And when that is the case, we can’t manage what we can’t see. So we can’t improve on a process that we don’t have any information for.”

Although the survival rate for people who go to trauma centers is 97%, the lack of information means they do not know what occurs before patients arrive at a trauma center.

“It’s time to look there,” Cook said, “for us to improve the care that injured people receive before they get to our doors.”

The research will allow them to look at interventions and outcomes in that phase of their care. From there, they can develop hypotheses on how to improve and develop interventions to test the hypothesis.

In his role in the project, Cook will analyze where trauma occurs, looking at the time it takes to get to a trauma center and how it influences patient outcome. He will do spatial analysis, analytic mapping, and analysis of spatially organized data using data from patients being brought to UT Health East Texas.

As a preliminary investigation, Cook took the addresses of all the trauma centers in Texas from the state website and mapped it against Census data for Texas.

“What I saw was about 12 or 13% of the Texas population lives outside of a one-hour drive to the hospital. That’s over a million people,” Cook said. “So we have some room for improvement.”

For rural East Texans, the time it takes to get to a trauma center is longer. It is important for researchers to gauge whether going directly to a trauma center or stopping at a smaller hospital can improve care.

“This is a great area for us to study to find ways to take care of the people in this region better and improve their outcome and improve their care,” Cook said.

As AI becomes a more common part of the conversation in the medical community, its use is being thoughtfully considered.

“It’s a very powerful tool,” Cook said. “But we have to be very mindful of the risks that it poses. Any tool misapplied can be a weapon.”

A wearable sensor

For her proposal of developing a wearable sensor to measure biomarkers through sweat of mild Traumatic Brain Injuries (TBI), Dr. Shawana Tabassum, UT Tyler Assistant Professor of Electrical Engineering, received funding for $100,000 from TRC4 for about 15 months.

“It will provide early identification of mild TBI at a much earlier stage than compared to an MRI or CT scans where the features are visible at a much later stage,” Tabassum said.

After an injury, the blood brain barrier becomes fragile, allowing some of the biomarkers to cross the brain and reach the blood. After entering the bloodstream, the biomarkers will circulate throughout the body. Through this process, they are transported to the sweat glands.

“There is a lot of research [that] has been done that sweat is very rich in different types of biomarkers, not just TBI, many other conditions express their biomarkers in sweat,” Tabassum said. “But very little research has been done on TBI. That’s where we come in.”

The wearable sensor will detect the biomarkers in sweat and use them to alert clinicians. Currently, they are in the research phase. In the next phase, they plan to test the device on mild TBI patients.

The device can also help those in the military with brain injuries. Tabassum hopes to use their research to apply to a larger grant, possibly with the Department of Defense. They want the device to help people identify the signs.

“Let’s say they are in a war zone or some remote area, this device will provide rapid identification, early identification,” Tabassum said. “And that will enable timely and effective treatment, also operational readiness by allowing quicker return to duty.”

Helping service members

After UT Tyler School of Medicine Associate Professor Dr. Tuan Le’s father was released from prison in Vietnam, his family was able to come to the United States as refugees. Le’s father was an ally with the U.S. government during the Vietnam War. In 1975, when the South Vietnam government fell, Le’s father was arrested as a political prisoner.

“We had faced severe discrimination during that time,” Le said.

Although Le was a physician in Vietnam, he faced many challenges and hurdles. In his work as a researcher, he hopes to find better prevention efforts for U.S. servicemembers. He is passionate about this topic due to his family history.

“I want to continue contributing my research to mitigate combat-related mortality and morbidity,” Le said. “[And] I appreciate the U.S. servicemember sacrifices for the freedom of my people during [the] Vietnam War.”

His project will look at traumatic and chemical injuries of U.S. service members from 2001-2023. His goal with this project is to identify trends and risk factors associated with trauma, inhalation and chemical injury and build toward life-saving interventions. He also plans to develop a new pre-hospital and mortality index which could be used as an early warning to better predict mortality in U.S. service members with trauma and chemical injury.

Hemorrhaging is the primary cause of death in the battlefield. However, it is preventable. The most common cause of injury for servicemembers were motor vehicle crashes and the misuse of machinery and equipment. This research can be applied to civilians. They hope to help implement better practices to help improve care after injury.

Through his previous research, it was found that giving patients two units of plasma reduced mortality rates by 30%. Researchers also found time mattered for patients; for patients who received interventions earlier, they found better results.

“If we want to reduce mortality, mitigate complication, we have to prepare where and we have to bring the medical care ability or capability close to the patient,” Le said.

For more information on TRC4, visit https://trc4.org/.