Emergency medicine research

We perform research in the emergency department setting at the Level 1 trauma center University of Vermont Medical Center, focusing on traumatic brain injury and acute traumatic coagulopathy.

Trauma surgeons have long struggled to manage the acute trauma-induced inflammation and coagulopathy which occurs in as many as one-fourth of patients after severe multi-system trauma. Refractory coagulopathy prevents optimal surgical management and can lead to death from otherwise survivable injuries. This is a complex physiological problem, involving multiple organ systems, with important public health significance.

Working with our collaborators at Denver Health/University of Colorado, we recently demonstrated that the fibrin architecture of clots generated from the plasma of trauma patients correlates with their fibrinolysis phenotype. Individuals with coagulopathy characterized by fibrinolysis shutdown had extremely densely cross-linked fibers that would likely be resistant to t-PA. These results are important in understanding the risk of transexamic acid and other anti-fibrinolytic therapies in the fibrinolysis shutdown subgroups of trauma patients, who are at the highest risk of multi-organ failure.

  1. Watts R, Thomas A, Filippi CG, Nickerson JP, Freeman K.  Potholes and Molehills: Bias in Diagnostic Performance of Diffusion Tensor Imaging in Concussion. Radiology (2014; 272(1):217-23). PMID: 24635677.
  2. Wylie G, Freeman K, Thomas A, Shpaner M, Okeefe M, Watts R, Naylor MR. Cognitive Improvement after Mild Traumatic Brain Injury Measured with Functional Neuroimaging during the Acute Period. PLOS One (2015; 10(5):e0126110). PMID: 25962067
  3. Mann KG, Freeman K. TACTIC: Trans-Agency Consortium for Trauma-Induced Coagulopathy. Journal of Thrombosis and Haemostasis. (2015; 13:S63-71). PMID: 26149052
  4. Neal MD, Moore HB, Moore EE, Freeman K, Cohen MJ, Sperry JL, Zuckerbraun BS, Park MS; TACTIC Investigators. Journal of Trauma and Acute Care Surgery. 2015;79(3):490-492. Clinical assessment of trauma-induced coagulopathy and its contribution to postinjury mortality: A TACTIC proposal. PMID: 26307885