Grants Funded

Abstract

Project Summary: Appropriate management of ischemic fingers requires rapid and accurate assessment. Our proposed research develops a technical solution for contactless real-time evaluation of perfusion after upper extremity injuries. Our current technology, DigiFlow, is valid and reliable for video evaluation of perfusion and is a novel option for evaluating injuries via video, substantially enhancing data available to the decision-making provider. The primary objective of this work is to convert DigiFlow to a secure and reliable smart phone version (DigiFlow Mobile) to eventually reach a wide variety of providers with varying skill sets and in any location. The proposed research will demonstrate the reliability and accuracy of DigiFlow Mobile. Our overall goal is to reduce delays in hand trauma care for those who acutely need it and to prevent over-triage and long-distance transfer for expert evaluation for those who do not need it. By employing various optimization techniques, we will refine our technology to perform well via mobile application by improving and addressing its current limitations such as sensitivity to light and motion. We will also enroll adult patients (>18 years) with hand lacerations, partial amputations, or ballistic injuries seen in the emergency department at The Curtis National Hand Center in Baltimore, Maryland. We will obtain iPhone camera videos of the injured hand and collect biometric data to confirm ground truth heart rate and hand perfusion. Once DigiFlow Mobile is optimized, patient injury videos will be processed, and we will use these videos to build a clinical test set to evaluate provider performance in detecting ischemia with and without our technology. We will confirm that our application DigiFlow Mobile is as valid and reliable as the current technology DigiFlow. The implementation of DigiFlow Mobile may aid in telemedicine efforts for remote trauma consultation and support from regionalized hand trauma centers, as well as improving identification and monitoring for ischemia at specialty centers. These findings may also eventually support other post-operative and remote monitoring efforts, including for the lower extremities (for example diabetic patients), breast reconstruction, and other soft tissue flaps.

Impact Statement: Identifying finger blood flow is a critical part of clinical assessment after injury but can be a difficult evaluation challenge depending on the situation and provider experience. However, proper treatment depends on the rapid and accurate recognition of at-risk tissue. Implementation of smart phone-based contactless technology can enhance how providers are able to evaluate injuries and can improve decision-making regardless of provider skill level or patient or injury characteristics. The outcomes of this research work will markedly improve trauma triage and management of hand injuries by avoiding treatment delays and unnecessary patient transfers, reducing treatment inaccuracies, and enhancing delivery of appropriate care for all patients with hand trauma.

Biography
Aviram M. Giladi, MD, MS is a board-certified and fellowship trained upper extremity surgeon at The Curtis National Hand Center and holds appointments of Assistant Professor in the Departments of Plastic Surgery at Georgetown University and Johns Hopkins University. He completed his medical degree at Vanderbilt University and residency in plastic and reconstructive surgery at The University of Michigan. During residency, he completed a Master’s in Health and Health Care Research. Dr. Giladi completed hand and upper extremity fellowship in the Department of Orthopaedics at Beth Israel Deaconess Medical Center. Dr. Giladi has a broad hand surgery clinical practice with a substantial volume of acute trauma care including revascularization and replantation. He also serves as Research Director for The Curtis National Hand Center and Scientific Director of Orthopedics for MedStar Union Memorial Hospital. His published research includes work on post-traumatic impairment and disability, delivery of upper extremity trauma care, and how trauma systems and networks affect care implementation and policy. As Research Director, he coordinates basic science, animal, biomechanics, and clinical outcomes studies through the Hand Center, and has a strong history of collaborative efforts across specialties and institutions. He is involved with many professional societies including active membership in the American Society of Plastic Surgeons and the American Society for Surgery of the Hand.