Injury Control COBRE Currently Funded Projects
The following projects are currently funded by Injury Control COBRE.
Research Project Leaders
Derivation of a Clinical Prediction Rule for Pediatric Abusive Fractures
Stephanie Ruest, MD, MPH, FAAP
Dr. Ruest is an assistant professor of pediatrics and emergency medicine. She is currently the pediatric emergency medicine trauma liaison and a Lifespan Injury Prevention Center faculty member. Her research interests include child abuse and neglect and injury prevention as well as social determinants of health, including food insecurity. She is a member of the Pediatric Emergency Care Applied Research Network (PECARN) Child Abuse and Neglect Research Interest Group as well as the Injury Prevention Research Interest Group, and a member of the Massachusetts Chapter of the American Academy of Pediatrics Foster Care Committee.
Project Summary
This study will utilize machine learning methods, including gradient boosted decision tree ensembles, to develop a clinical decision rule that will identify children at high risk of abuse among patients ≤5 years with fractures presenting for emergency department (ED) care.
Dr. Ruest will analyze structured variables in the electronic health record of patients with fractures evaluated in the Hasbro Children’s Hospital (HCH) ED and HCH Child Protection Program over a six-year period (2014-2020) using descriptive statistics, apply natural language processing techniques to extract data from clinical narratives and radiology reports to generate text-derived variables, employ machine learning techniques to identify predictor variables to derive and refine a CDR, and 4) validate this CDR with a different HCH ED cohort of patients seen between 2021-2023.
The development and refinement of a CDR will inform the design of a prospective multi-center study for broad validation of CDR’s ability to identify high-risk patients.
The Development of a Family Navigator Protocol to Reduce Risk of Suicide and Self-injurious Behavior for Youth Aged 10 to 14 Years
Mary Kathryn Cancilliere, PhD
Mary Kathryn Cancilliere, PhD, is a pediatric psychologist and research scientist in the Department of Child and Adolescent Psychiatry at Rhode Island Hospital and assistant professor (research) in the Department of Psychiatry and Human Behavior at the Alpert Medical School of Brown University. Overall, Dr. Cancilliere’s program of research aims to develop interventions and prevention protocols while leveraging digital health technology for youth injury prevention and control during acute psychiatric risk (i.e., suicidal and non-suicidal self-injurious behaviors) and their families in the Pediatric Emergency Department, Psychiatric Emergency Services.
Project Summary
This study will develop and examine the feasibility and acceptability of a family navigator protocol while leveraging digital health communication. It will employ an ecological model within a socio-cultural theoretic framework of mental health service disparities and barriers to treatment.
Dr. Cancilliere will recruit 80 youth aged 10 to 14 years experiencing suicidal and non-suicidal self-injurious behaviors risk admitted to Hasbro Children’s Hospital emergency department (ED) and referred to psychiatric emergency services, and their caregivers. Balanced randomization will occur to either the treatment-as-usual condition or the family navigator with digital health communications. Following youth discharge from the ED, the family navigator condition will receive bi-weekly by phone or video conferencing on mental health service attendance, review the disposition plan including referral to mental health care, review the youth safety plan, and address barriers to care. Post-intervention session evaluations and qualitative exit interviews will be used to explore attitudes and opinions regarding intervention content and delivery. Primary outcomes, measured at four- and six-month follow-ups, include reduced suicidal and non-suicidal self-injurious behaviors risk and prevalence rates, increased attendance and adherence to youth community-based mental health care, and the engagement of the purported therapeutic mechanisms.
Overall, this study aims to reduce youth suicidal and non-suicidal self-injurious behavior risk and prevalence rates by increasing linkage to community-based mental health services.
New Potential to Restore Neuromuscular and Joint Function after ACL Injury
Jill Beveridge, PhD
The project objective is to determine whether the novel bridge-enhanced anterior cruciate ligament restoration (BEAR) procedure restores biomechanical knee function compared to the standard of care anterior cruciate ligament reconstruction (ACLR), leading to improved patient outcomes after ACL injury. The BEAR procedure differs from ACLR as it uses a scaffold to promote healing of the injured ACL whereas ACLR requires removal of the entire ligament, which severs and then removes neural structures within the native ACL.
Clinical studies of BEAR have shown that muscle strength is restored following BEAR but not after ACLR, even at two years. BEAR patients also reported superior sports-related quality of life earlier in their recovery. The study postulates that these differences are due to the preservation of neural activity and neuromuscular feedback with BEAR. Therefore, the overarching hypothesis is that BEAR preserves the neuromuscular activation patterns about the knee that, in turn, promote normal hop landing joint motion and corresponding patient-reported outcomes compared to ACLR. If the hypotheses of the proposed study are supported, the results will demonstrate that neurophysiological mechanisms underlying BEAR recovery are fundamentally different from ACLR and that they have a significant impact.
Pilot Projects
A Feasibility of a Smartphone-Based App to Assess Chronic Pain and Disability after Rib Fractures Study
Tareq Kheribek, MD, ScM
Tareq Kheirbek, MD, ScM is a trauma and acute care surgeon at Rhode Island Hospital focused on trauma resuscitation, chest wall injuries, soft tissue injuries and reconstructions, as well as emergent general surgery. Research interests include surgical outcome research, especially in prehospital resuscitation, resource utilization, and surgical rib fixation. Dr. Kheirbeck was granted an Injury Control COBRE pilot project award in March 2023 for the study “A Feasibility of a Smartphone-Based App to Assess Chronic Pain and Disability after Rib Fractures Study.” The Injury Control COBRE Pilot study objective is to evaluate the feasibility of a smartphone-based app to collect self-reported assessment of pain and its recovery among patient with acute rib fractures.
Creation of an Implementation Strategy Package for the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) Intubation Checklist
Robyn Wing, MD, MPH, FAAP
Robyn Wing, MD, MPH, FAAP is a pediatric emergency medicine physician and an associate professor at The Warren Alpert Medical School of Brown University. She is also the director of pediatric simulation at the Lifespan Medical Simulation Center. Dr. Wing's research focuses on medical education and quality improvement, including simulation-based training and teamwork. She co-founded the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) and was awarded the American College of Emergency Physicians (ACEP) Junior Faculty Teaching Award in 2022. Dr. Wing was granted an Injury Control COBRE pilot project award in January 2024 for her study “Creation of an Implementation Strategy Package for the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) Intubation Checklist.” The objective of the Injury Control COBRE Pilot study is to use the Exploration, Preparation, Implementation, Sustainment (EPIS) framework and the Consolidated Framework for Implementation Research (CFIR) with ERIC strategies to guide our implementation of the N4P Intubation Checklist in PEDs.
Predicting Clinical Outcomes in Older Adults with Rib Fractures
Sarah Keene, MD
Sarah Keene, MD, is an emergency medicine physician specializing in geriatric care and an assistant professor at the Warren Alpert School of Medicine. She is renowned for her expertise in managing complex injuries in older adults. Her research focuses on predicting clinical outcomes in older adults with rib fractures, aiming to address the challenges in managing such injuries and reducing associated morbidity and mortality rates while optimizing healthcare resource utilization.
Dr. Keene's study will investigate the clinical trajectories of older adults presenting with rib fractures at a regional level I trauma center, aiming to identify key patient characteristics, injury mechanisms, and physiological markers correlating with adverse clinical outcomes. She plans to characterize the patient population and explore relationships between injury severity, physiological parameters, and adverse events.
The ultimate goal of Dr. Keene's pilot project is to develop a robust risk-stratification tool capable of accurately predicting which older adults with rib fractures are at high risk of developing complications necessitating intensive care, revolutionizing clinical decision-making, and optimizing resource allocation. She anticipates validating the tool and evaluating its feasibility among Emergency Medicine physicians and trauma surgeons, aiming to improve outcomes and set new standards in geriatric trauma management through dedication and innovation.