Funded Injury Control Research Centers (ICRCs)

Project Title: Grants for Injury Control Research Centers
Grant Number: CE001175
Project Period: 08/01/2007 - 07/31/2012
Description: See funded ICRC page for more information.

Project Title: Quality of Life After Trauma: A Prospective Study to Evaluate Functional Outcome and Health Status after Moderate to Severe Trauma
Project Period: 08/01/01-07/31/06
Description: This is a prospective study that aims to evaluate patients’ functional outcome and health status after moderate to severe trauma. The study will also examine patients’ injury severity, types of injury, and degree of social support. The ability to use several sub-scale scores to derive a single utility value for health status will also be studied.

All patients with moderate to severe trauma will be surveyed 1, 6, 12, 18, and 24 months post-injury. Self-administered questionnaires will include two measures of generic quality-of-life measures and one functional outcome measure. Inclusion criteria include age 10 and older, with moderate or severe injury measured by the Injury Severity Score (ISS>9). Project duration is five years. Patient enrollment will continue for three years; patients will be followed for two years after enrollment. Study results will be used to determine the optimal time for measuring generic health status and functional recovery after trauma, and to derive a method of ascertaining a single value for quality of life useful in health services research.

Project Title: Risk Factors for Medical Injury in Hospitalized Patients
Project Period: 08/01/01-07/31/06
Description: Concerns about patient safety are receiving unprecedented attention in the health policy arena and general news media. A number of approaches (legal, managerial, and epidemiologic and health services research) have been used to address patient safety and medical injury. The project’s premise is that injury control science provides a coherent and systematic philosophical framework and valuable methodological tools for researching and preventing medical injuries. In light of the expansive scope of injury control, injuries arising from diagnostic or therapeutic health-care interventions are a glaring omission from traditional injury control activity. To further the application of injury control science to medical injury and patient safety, a case control study will be conducted to identify risk factors for medical injury in hospitalized patients. This will be the first comprehensive application of the Injury Control Model (ICM) to the analytic study of medical injuries and will lay the foundation for future work by refining and evaluating epidemiologic methods for medical injuries and laying groundwork for in-depth studies and interventions to prevent medical injuries.

The primary aim is to quantify the association of specific hypothesized risk factors with the occurrence of medical injury: demographic characteristics (age, sex, insurance status); severity of underlying illness or injury; co morbidities; number and nature of health-care interventions; and specific diagnostic and therapeutic interventions. A secondary aim is to refine, demonstrate, and evaluate methods for conducting hospital-based analytic research of medical injury—including case definitions and control selection criteria, severity of illness assessment, and classification of medical interventions.

Project Title: Clinical Biomechanics of Penetrating Traumatic Brain Injury
Project Period: 08/01/01-07/31/06
Description: As treatment methods of penetrating wounds to the head become more advanced and duration of time between injury and treatment shortens, these wounds warrant further study. Factors that affect the survivability of gunshot wounds to the cranium include the type of weapon, the projectile, and the location of trauma. High-velocity projectiles through the brain impart tremendous pressures within the tissues, inducing strains that may or may not produce permanent damage to the structures. The pressures in and immediately around the wounding track are known to cause damage. The potential for a larger wounded area due to secondary pressures has not been thoroughly examined. The specific hypothesis is that the penetrating traumatic brain injury (TBI) wound energy is directly related to the magnitude of pressure wave distributions within the cranial vault that occur during the traumatic event and that additional wounded areas may occur if the secondary pressures reach damaging magnitudes. The specific objectives are linked to both short- and long-term patient outcome. For the short-term, the principal issues are the determinants of initial survivability. It is anticipated that these determinants will include the wounding energy and missile trajectory.

The physical stimulant models have the advantage of direct filming of high-speed projectiles using the latest high-speed digital videography (18,000–40,000 f/s). To better understand survivability, this project will create a series of physical models and computer finite element (FE) models that will characterize and quantify the mechanics associated with wounding energy. Patients who survive penetrating TBI often require treatment for various combinations of motor, sensory, cognitive, or behavioral impairments. Using advanced imaging techniques, tools for visualizing the patient-specific tissue damage to assist the clinician in the continued treatment of these patients will be developed.

Project Title: An Analysis of Violence-Related Fatalities and Injuries in Wisconsin
Project Period: 08/01/01-07/31/04
Description: Homicides and suicides are a significant public health problem, accounting for approximately 48,400 deaths in 1998 in the United States. This project will investigate trends and epidemiological patterns of intentional injury fatalities and nonfatal intentional injuries in Wisconsin using a comprehensive Statewide Violence Fatality Reporting System. This system, which links medical examiners/coroners, law enforcement agencies, and crime labs, will include all Wisconsin homicides and suicides. It will also examine trends in violence-related injuries, in collaboration with the Wisconsin Department of Health and Family Services, using the statewide hospitalization discharge data set and a statewide emergency department data set. This combined morbidity and mortality data set will enable researchers to examine the spectrum of violent events and describe and contrast emerging trends and characteristics for these deaths and nonfatal events.

This project has three essential elements. The first component will analyze the linked information to answer several questions, including: What changes in suicide and homicide rates and patterns occur over time associated with the method used; victim (homicide and suicide) and perpetrator (homicide suspect) characteristics and relationships including criminal records, urban/suburban/rural circumstances, and locations; changes related to implementation of new policies that address perpetrators/victims; environment; and weapon availability? Second, the research will also evaluate system data completeness, consistency, and accuracy. Third, by linking the intentional injury deaths with nonfatal hospital discharges and emergency department admissions, additional important questions can be addressed. These include the relationship of the method of attempted suicide (e.g., drugs, firearms, other categories) to age, sex, urban or rural location of residence, hospital mortality, length of stay, hospital charges and costs, and age- and cause-specific case fatality ratios.

Project Title: Psychological Treatment of Acute Stress Disorder Following Traumatic Injury
Project Period: 08/01/01-07/31/04
Description: This prospective cohort study investigates the psychological adjustment of individuals who suffered traumatic physical injuries. It examines the influence of subject, trauma, and injury variables on psychological well-being after injury and emphasizes six factors: causal attributions, self-efficacy, spiritual/religious values, and perceived level of social support, anger, and personal coping resources. Outcome data include measures of the intensity of post-traumatic stress disorder (PTSD) and depression symptoms. Changes in pre- and post-injury alcohol use will also be examined.

One hundred and fifteen subjects will be interviewed within 2 to 14 days post-injury and in follow-up at 1, 3, and 6 months. Inclusion criteria include age 18 and older; current diagnosis of traumatic injury from accidents; and non-assaults resulting in soft tissue, internal, and orthopedic injuries that require inpatient medical care longer than 48 hours. Project duration is 3 years. Study results will be used to improve early psychological intervention with trauma patients to prevent the development of long-term PTSD and depression symptoms.

Project Title: Injury Fatalities of U.S. International Travelers
Project Period: 08/01/01-07/31/04
Description: The first objective of this study is to quantify and examine patterns of regional- and country-specific injury deaths among travelers controlling for age, economic development of destination country, and duration of stay in destination country. This will be achieved by (1) collecting available years of data from the U.S. State Department Passport Office; (2) examining and linking appropriate international travel denominator sources; (3) calculating injury-mortality rates by cause, region, country, and level of economic development; (4) performing age and gender adjustment; and (5) assessing how economic development affects travelers' injury mortality rates. The second objective is to examine how risk is associated with travel exposure by comparing traveler injury mortality rates with those of U.S. citizens residing in the United States and those of residents of travelers' region or country of destination.

This will be the first longitudinal analysis that examines trends in injury-related deaths of U.S. international travelers. This type of analysis will have several advantages, such as increased power, identification of emerging patterns, and an ability to undertake a detailed analysis of risk factors. Death reports from the U.S. Passport Office will be used to abstract data from reports filed by U.S. Counselor Officers around the world for 1998, 2000, and 2002. Proportionate mortality ratios will be applied to measure the risk from injury fatality to U.S. travelers as compared with the risk of injury mortality to residents of the destination country.