Trauma Research Team at UH Challenges the Status Quo
June 23, 2025
UH Clinical Update | June 2025
The team that makes up the University Hospitals Division of Trauma, Critical Care, and Acute Care Surgery necessarily spends most of its time in direct patient care, providing lifesaving interventions. However, the 13 physicians and allied health workers who provide this vital service are also engaged in important research – with the goal of always improving the care they provide.
Their work falls into three general categories, says James Ross, MD, Director of Research for the division. One focus is on process and quality improvement, with a special emphasis on the use of blood products.
“Ever since the pandemic, there have been ongoing blood shortages, and they're only anticipated to worsen,” Dr. Ross says. “As trauma, we're a major user of blood in the system, so a lot of our work in the last couple years has been focused on how we most efficiently use limited blood resources.”
One pertinent example is patients with asymptomatic anemia.
“Their hemoglobin is low, either because they were bleeding in the past, or they have critical illness, or they always run low,” Dr. Ross says. “We and others across the country routinely transfuse patients for what we call asymptomatic anemia below a hemoglobin threshold of 7. We are really interested in whether that's actually necessary or whether the patients will bounce back on their own.”
There’s a misconception, Dr. Ross adds, that blood transfusions have no potential downside.
“Blood has side effects as well,” he says. “In addition to being a limited resource that's critically lifesaving in some patients, using excess blood is expensive and potentially harmful.”
Trauma researchers at UH are also studying ways to maximize the best and most efficient use of blood. Work from UH trauma surgeon Andrew Loudon, MD, and colleagues has led to 1,695 units of packed red blood cells/fresh frozen plasma saved in 30 months, with a 14% increase in proportion of blood transfused to survivors and no change in mortality.
The focus on blood also extends to a second priority area for UH trauma research – the process of hemolysis, or the destruction of red blood cells.
“We study hemolysis and the breakdown of red blood cells in trauma, and how that contributes to injury to the endothelium and organs,” Dr. Ross says. “This work addresses what happens to red blood cells when they've been transfused, how they break down and how that could that be deleterious.”
In fact, Dr. Ross recently submitted a proposal to the National Institutes of Health to fund this work – based in part on some earlier results generated from smaller grants.
Dr. Ross and the division’s researchers are also collaborating with the UH Department of Anesthesiology on a study investigating the impact of large-volume transfusions in injured patients.
“We give blood transfusions to replace what the patient has lost,” he says. “That's the goal. You give a lot of blood, deliver oxygen to the tissues, and prevent organ injury. But whether that’s strictly true is an open question. As a result, we have an ongoing study with the UH anesthesia group, studying the impact of massive transfusion on tissue perfusion in injured trauma patients who come to the ICU.”
A third area of trauma research at UH is quite different from the other two, dealing with patients at UH who have been the victims of violence and what services are best geared to help them heal and move on with their lives.
“The most likely person to be injured is the person who's already been injured,” Dr. Ross says. “If we can identify those patients and intervene to get them the resources they need starting in the hospital, with a ‘warm handoff’ to community partners who can help, we can try to break the cycle.”
In fact, Glen Tinkoff, MD, System Chief of Trauma and Acute Care Surgery, and UH trauma surgeon Brian Young, MD, are working through the Northeast Ohio Trauma System (NOTS) to study the effectiveness of the program and how it can work best for patients.
“When a firearm violence victim comes in, it’s often a highly emotional situation, not only for the patient but the family,” Dr. Tinkoff says. “De-escalation is often needed so that we can move the patient through their hospitalization. What the program's about is providing resources and coordinating community services. In assessing victims of violence, we want to seek change in their environment and provide them with the resources to do so, while following them over a year or two to see if they can maintain a path free from violence to one of productivity.”