A patient’s chances of surviving a severe injury can depend on decisions made long before the patient reaches the operating room. Information from the crash scene, an ambulance, the trauma bay, surgery, and the ICU may each shape care, and yet those pieces of information do not always reach the next team in a form it can use.
Renowned trauma surgeon and researcher Michael F. Rotondo, MD, FACS, will ask whether digital transformation can help close those gaps in today’s Scudder Oration on Trauma, “The Last Preventable Death: Will Digital Transformation Change Injury Care Forever?”
“Digital transformation in injury care is not any single device or algorithm,” said Dr. Rotondo, professor of surgery in the Department of Surgery, Division of Acute Care Surgery at the University of Rochester School of Medicine and Dentistry in New York. “It is the integration of continuous data and analytics across a patient’s entire journey, so that what we learn from one patient improves the care of the next.”
A Decades-Long Pursuit
The push toward digital transformation builds on a decades-long effort to reduce preventable deaths after injury.
Dr. Rotondo will trace that effort from the 1966 Accidental Death and Disability report through the development of trauma centers, Advanced Trauma Life Support®, risk-adjusted outcomes measurement, the National Trauma Data Bank, and the ACS Trauma Quality Improvement Program. He also will examine lessons from military and civilian trauma care and the evolution of critical care and resuscitation.
His own work has helped shape several chapters of that history. Early in his career, he and colleagues published influential work on damage control surgery, an approach that changed the treatment of patients with severe bleeding. He later directed a Level I trauma center, served as Chair of the Committee on Trauma (COT), and helped establish standards for trauma centers and systems. He also led a military-civilian team that evaluated trauma care in Afghanistan.
The Promise of Connected Care
Despite that progress, Dr. Rotondo notes that two problems persist: clinicians do not always agree on what constitutes a preventable death, and data remain fragmented across the continuum of care.
His lecture will offer a framework for addressing those problems through six connected elements: datafication, connectivity, analytics, artificial intelligence (AI), automation, and a system that continually learns from its results.
To show what such a system might look like, Dr. Rotondo will present a hypothetical, fully connected trauma network. He also will discuss emerging applications across the patient journey, including automated crash notifications, AI-supported triage, operative video analysis, and other developing technologies.
The possibilities are substantial, but Dr. Rotondo will distinguish between a compelling concept and proven clinical benefit.
“The evidence base for AI in trauma and acute care surgery is expanding quickly, from risk prediction in resuscitation to deterioration monitoring in the ICU,” he said. “Much of it remains early stage, and the discipline’s task now is to evaluate and integrate these tools deliberately, rather than adopt them uncritically.”
Connected systems may help teams recognize danger sooner and learn faster from every patient, but the responsibility for acting on that knowledge will still rest with clinicians.
“These technologies will extend what we can observe and predict, but they do not change what is asked of a surgeon: sound judgment under uncertainty, and attention to the patient as a person, not only a data set,” Dr. Rotondo said. “Progress toward eliminating preventable death will depend on both.”
The Scudder Oration on Trauma, sponsored by the ACS COT, will be held from 12:45 to 1:45 pm in Ballroom C of the Walter E. Washington Convention Center. The lecture will be available on demand shortly after the live presentation.
