Marian R. Passannante, PhD, associate professor, UMDNJ-New Jersey Medical School and UMDNJ-School of Public Health

More than 10 years ago David Livingston, MD, Chief of Trauma at UMDNJ-University Hospital, posed the following question: “Can we safely send patients home from the hospital rather than admitting them for observation if they present with minimal head or minor abdominal trauma?” To answer this question, we needed to design an epidemiologic study at trauma centers around the country. Along with a team of clinical investigators, we developed a research protocol funded by the Agency for Health Care Policy Research. The results of this outcomes study changed clinical practice, while decreasing the costs associated with unnecessary hospital admissions.

In the 1990s, hospitalization for observation was the standard of practice for patients who had sustained a blunt abdominal trauma and who did not require emergent operation, even when the presence of an intra-abdominal injury had been excluded by diagnostic studies. Similarly, hospitalization for observation was the standard of care for those who sustained a minimal head injury, even when diagnostic studies had excluded the presence of an intracranial injury. The reasons for this practice are multi-factorial and include the perceived false-negative rate of standard diagnostic tests, the belief that hospitalization would allow for the prompt diagnosis of occult injuries, and medico-legal considerations about the risk of early discharge.

In a prospective, multi-institutional study over 22 months at four geographically diverse Level I trauma centers around the country, by either physical examination or mechanism of injury, all patients with blunt abdominal trauma and minimal head injury were evaluated using a standard protocol. Analyses of data, which included more than 2,000 patients with each type of injury, suggested that patients who had a negative CT scan after suspected blunt abdominal trauma did not benefit from hospital admission and prolonged observation. In addition, patients with a cranial CT scan, obtained on a helical CT scanner, that showed no intracerebral injury and who did not have other body system injuries or a persistence of any neurologic finding, could be safely discharged from the emergency department without a period of either inpatient or outpatient observation. The results of this multi-center trial were presented at various professional meetings and published in trauma journals. More important, this outcomes study had the impact of changing clinical practice, while decreasing the costs associated with unnecessary hospital admissions. This study was the first of a number of collaborative studies with researchers at the UMDNJ-University Hospital Trauma Center and was the beginning of my interest in the study of the epidemiology of trauma. More recently, I have been working to establish the Injury Research and Prevention Work Group. Injury (intentional and unintentional) is the leading cause of death among individuals age 1 - 44 in the U.S. and ranks in the top 10 causes of death for individuals of all ages. For those 1 - 34 years of age, unintentional injuries are the greatest cause of death, while homicide and suicide rank in the top four causes of death for this age group. Injury is also a major cause of morbidity, including disability. According to the CDC, an estimated 5.3 million people in the U.S. have long-term disabilities from traumatic brain injury and 200,000 from spinal cord injury. The importance of injury-related morbidity and mortality as a public health problem is further reported in Healthy People 2010, which states that injury as a result of violence is one of the nation's leading health indicators. The goal of the Injury Research and Prevention Work Group, which I chair, is to encourage active collaboration among injury researchers from a variety of disciplines, public health practitioners, state and local health departments, nonprofit agencies and industry for the purpose of identifying and studying the major causes of injury and disability in New Jersey, New York, Puerto Rico and the Virgin Islands. We are also developing and testing innovative strategies to address the major causes of injury in these geographic areas.

Our multi-disciplinary group of researchers has been meeting since March 2002 to develop collaborative injury research projects and to apply for external funding to support this work. The group comprises faculty members from UMDNJ's New Jersey Medical School, the Violence Institute of New Jersey, School of Nursing and School of Public Health. Researchers from affiliated institutions include Kessler Medical Rehabilitation Research and Education Corporation, the War-Related Illness and Injury Study Center, Rutgers University, the New Jersey Department of Health and Senior Services, Morristown Memorial Hospital, Jersey Shore Medical Center and Safe Horizon. Community groups such as the Brain Injury Association of New Jersey, and researchers and public health officials at the New York City and New York State Health Departments, the State University at Albany-School of Public Health, the University of Puerto Rico, the Puerto Rico Department of Health and the Office of the Commissioner of Health of the Virgin Islands are also part of the group.

One example of a multi-disciplinary project that has resulted from this collaboration is the CDC-funded New Jersey Violent Death Reporting System. These surveillance data will be used to educate public health and public safety professionals in the state to influence their interventions and decision-making, with the ultimate goal of reducing the incidence of violent deaths. Surveillance data will be created by combining vital statistics, autopsy, and law enforcement data. Using death certificates, medical examiner reports, supplemental homicide reports, and ballistics data, an annual report on violent deaths in New Jersey, GIS mapping of violent death “hot spots,” and a public use file for researchers will be developed.

Marian R. Passannante, PhD, is an associate professor of biostatistics and epidemiology at UMDNJ's New Jersey Medical School and School of Public Health. Dr. Passannante received her PhD from the Johns Hopkins University School of Hygiene and Public Health. She is a founding member of the UMDNJ-School of Public Health on the Newark campus and serves as an epidemiologist on a range of grant-funded NIH and CDC projects. Dr. Passannante is also a member of the UMDNJ Master Educators' Guild. §