A team of military and civilian researchers have studied blood and tissue samples to identify a model capable of predicting the likelihood of successful wound healing in individual patients. Such predictive ability could aid surgeons in making critical, time-sensitive decisions, including when to close a wound, as both premature and late closing can cause serious complications.
The team, comprising researchers from the Naval Medical Research Center, Memorial Sloan-Kettering Cancer Center, Emory University, Duke University Medical Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (all USA), collected blood, tissue and serum samples from 73 patients who had sustained 116 life-threatening wounds while in combat in Iraq or Afghanistan. Biomarkers data from these samples were analyzed, along with clinical observations, to provide a prediction of the likelihood of wound failure. Samples were obtained prior and during each surgical debridement of the wound
Prognostic models were derived from these samples through the use of computer intensive methods and subsequently internally validated using target shuffling and cross-validation methods. The resulting model uses the presence of cytokines to predict which patients would go on to develop an inflammatory response that would lead to local wound failure, which can result in infection, amputation or death.
It is hoped that the resulting decision-support tool will help guide the timing of wound closure, although the authors note that by employing numerous samples and advanced computer analysis, the technique would be limited to a field hospital setting and not available on the frontline.
In a further analysis, 18 critically injured civilian patients were evaluated for the presence of similar inflammatory responses. Preliminary findings were reported to be comparable but strongly limited by the small sample size.
If these data can be further validated, the authors conclude: “consistently applying this approach would improve surgical outcomes, allow trauma patients to spend less time in intensive care, and reduce health care costs.”
Written by Hannah Wilson
Sources: Forsberg J, Potter B, Wagner M, et al. Lessons of War: Turning Data into Decisions, EBioMedicine, doi: 10.1016/j.ebiom.2015.07.022 (2015) (Epub ahead of print); Newswise Press Release. Researchers Identify Model to Predict Successful Wound Healing. www.newswise.com/articles/researchers-identify-mod...