Patient-Specific Precision Injury Signatures to Optimize Orthopaedic Interventions in Multiply Injured Patients (PRECISE STUDY)

Abstract

Optimal timing and procedure selection that define staged treatment strategies can affect outcomes dramatically and remain an area of major debate in the treatment of multiply injured orthopaedic trauma patients. Decisions regarding timing and choice of orthopaedic procedure(s) are currently based on the physiologic condition of the patient, resource availability, and the expected magnitude of the intervention. Surgical decision-making algorithms rarely rely on precision-type data that account for demographics, magnitude of injury, and the physiologic/ immunologic response to injury on a patient-specific basis. This study is a multicenter prospective investigation that will work toward developing a precision medicine approach to managing multiply injured patients by incorporating patient-specific indices that quantify (1) mechanical tissue damage volume; (2) cumulative hypoperfusion; (3) immunologic response; and (4) demographics. These indices will formulate a precision injury signature, unique to each patient, which will be explored for correspondence to outcomes and response to surgical interventions. The impact of the timing and magnitude of initial and staged surgical interventions on patient-specific physiologic and immunologic responses will be evaluated and described. The primary goal of the study will be the development of data-driven models that will inform clinical decision-making tools that can be used to predict outcomes and guide intervention decisions.

Preclinical models of orthopaedic trauma: Orthopaedic Research Society (ORS) and Orthopaedic Trauma Association (OTA) symposium 2022

“…15,16 Other groups are examining cytokines as markers of injury severity in patients to test the hypothesis that composition, levels, and timing of cytokine profiles will serve as predictors of trauma severity, healing potential, and dictate when to operate. [17][18][19][20] The in vivo work to date is promising, and while there is still much more to be done, translatable animal models will serve as an important step.…”

Musculoskeletal Biorepository: Establishment, Sustainment, and Tips for Success

“…Robust biorepositories also offer the ability to bring an approach of precision medicine to patients by leveraging biomolecular signatures to deliver the right care for each patient at the right time. [18][19][20][21] Precision medicine has been defined as "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person". 22 The basis of precision medicine is that the same treatment may not be as effective for every patient with the same disease process.…”

“…23 The use of precision medicine is, however, limited in the orthopaedic literature and to date has focused primarily on optimizing interventions for patients with traumatic injuries. 20 Biorepositories for many orthopaedic conditions would potentially offer the ability to provide precision medicine for patients based on unique biomolecular signatures and genetic profiles.…”

The Major Extremity Trauma Research Consortium: Development and Impact of an Orthopaedic Trauma Research Program

“…The magnitude and duration a patient's inflammatory response varies, and major nonlifesaving orthopaedic procedures performed during an inflammatory storm can affect the risk of pulmonary and systemic complications. The PRECISE study 17 was designed to leverage a multidisciplinary precision medicine approach to improve trauma care in patients sustaining major orthopaedic injuries. Patient-specific indices that measure cumulative hypoperfusion, volumetric mechanical tissue damage and individual acute immunologic response to injury have been developed.…”