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Section Chief of Trauma in the Division of Acute Care Surgery and Surgical Critical Care
Brown Universtiy
WAKEFIELD, Rhode Island
OMB No. 0925-0001 and 0925-0002 (Rev. 09/17 Approved Through 03/31/2020)
BIOGRAPHICAL SKETCH
NAME: Stephanie Lueckel, MD, ScM
eRA COMMONS USER NAME (credential, e.g., agency login): slueckel
POSITION TITLE: Section Chief of Trauma in the Division of Trauma and Surgical Critical Care
EDUCATION/TRAINING:
INSTITUTION AND LOCATION DEGREE
(if applicable) Completion Date
MM/YYYY FIELD OF STUDY
Wellesley College, Wellesley, MA BA 2000 Economics
Temple University School of Medicine, Philadelphia, PA MD 2005
Tufts Medical Center / Tufts School of Medicine, Boston, MA Residency 2005-2010 General Surgery
R Adams Cowley, Baltimore, MD Fellowship 2012 Trauma Surgery Critical Care
Brown University, Providence, RI ScM 2016 Clinical and Translational Research
A. Personal Statement
Role on this Project: My goal is to improve the care of elderly patients with traumatic injuries, including care at the end of life. To this end, my current research has two aspects; 1) a better understanding of the ICU and hospital care of elderly patients who require post-acute care placement and 2)a better understanding of the outcomes, and area for improving and optimizing functional long term recovery, in the elderly trauma population which requires post-acute care. This topic is of enormous scientific and clinical and importance. Dedicated trauma systems, internationally accepted standards of care and improvements in ICU management have decreased trauma related mortality. However, these advances have mostly benefited young patients. Further, among survivors, discharge to skilled nursing facilities still encompasses a massive burden upon both the patient and society and does not always equate to normal functional recovery, especially in elderly patients. To date, I have focused on both pre-hospital factors as well as key aspects of trauma ICU care that affect trauma outcomes. I have noted that elderly patients are more likely to present in a delayed fashion (>24 hours) following trauma and are more likely to suffer significant complications compared to those who present early. Further, I have demonstrated that ICU level of care, especially invasive monitoring and appropriate nutritional support, needs to be optimized to prevent complications which may further delay discharge and complicate post-discharge care. As a trauma and critical care surgeon, I care for a large volume of critically ill trauma patients. I have focused my clinical and leadership roles on quality improvement care of elderly patients who have suffered from trauma. I have developed in-hospital protocols, and serve as the Medical Director for a Trauma Intensive Care Unit and a Surgical Intensive Care Unit. Additionally, my Masters in Clinical and Translational Research from Brown University has provided me with the necessary tools to analyze both large and small population data sets. My interest in trauma, geriatrics and end of life care is supported by the department of surgery as well as tight collaborations I have formed with the geriatrics division at Rhode Island Hospital.
Qualifications: I am a board certified Surgical Intensivist Section Chief of Trauma in the Division of Trauma and Surgical Critical Care at Rhode Island Hospital, and a physician-scientist with a focus on improving the care of patients with traumatic injuries, as well as improving the support provided to the families of these patients. My research, clinical care, and patient advocacy has centered on improving both the acute and long-term care of trauma patients. In my leadership role at Rhode Island Trauma Center and Chair of the Committee on Trauma for Rhode Island, I have led quality improvement initiatives to standardize and optimize the care of trauma patients. Additionally, I sit on the Palliative Care Committee for the American Association for the Surgery of Trauma which focuses on discussions with patients and families regarding critical illness and prognosis. My clinical expertise is accompanied by advanced research training, poising me to successfully execute the proposed study. Through the Masters in Clinical and Translational Research program at Brown University, I have acquired both the methodologic and analytic skills necessary for this project. I have successfully obtained external funding and have completed important preliminary work that is informing the proposed investigation. I am a Co-I on two PCORI funded studies(PCS-1511-32745, PCORI-PFA-2017 ) involving acute trauma care regarding blood clot prevention as well as long-term trauma care looking at methods to match patients acute care with their post-acute care in the MDS database. I also serve as a Co-I on an R21 (R21AG059120) which also aims to match the acute care with the long-term care of patients suffering traumatic brain injury. The following publications highlight relevant previous work:
1. Gregg SC, Heffernan DS, Connolly MD, Stephen AH, Lueckel SN, Harrington DT, Machan JT, Adams CA Jr, Cioffi WG. Teaching Leadership in Trauma Resuscitation: Immediate feedback from a real-time, competency-based evaluation tool shows long-term improvement in resident performance. J Trauma Acute Care Surg, 2016 Oct: 81(4):729-34. PMID: 27488489.
2. Roden-Foreman JW, Rapier NR, Foreman ML, Zagel AL, Sexton KW, Beck WC, McGraw C, Coniglio RA, Blackmore AR, Holzmacher J, Sarani B, Hess JC, Greenwell C, Adams CA, Lueckel SN, et al. Rethinking the definition of major trauma: The Need for Trauma Intervention outperforms Injury Severity Score and Revised Trauma Score in 38 adult and pediatric trauma centers. Journal Trauma Acute Care Surg, 2019 Sep;87(3):658-665. PMID: 31205214.
3. Lueckel SN, Teno JM, Stephen AH, Benoit E, Kheirbek T, Adams CA Jr, Ciofffi G, Thomas KS. The Population of Patients with Traumatic Brain Injury (TBI) in Skilled Nursing Facilities: A Decade of Change. J Head Trauma Rehabil, 2019 Jan/Feb;34(1):E39-45. PMID: 29863612. PMCID: PMC6274633 [Available on 2020-01-01].
4. Lueckel SN, Kosar CM, Teno JM, Monaghan SF, Heffernan DS, Cioffi WG, Thomas KS. Outcomes in Nursing Home Patients with Traumatic Injury. Surgery, accepted May 2018. PMID: 29751966.
B. Positions and Honors
Positions and Employment
2010 Volunteer Surgical Consultant, Kamuzu Central Hospital, Lilongwe, Malawi
2011 Surgical Consultant, Brockton Hospital, Brockton, MA
2012-Present Assistant Professor of Surgery, University Surgical Associates, Providence, RI
2012-Present Active Surgical Staff, Women & Infants Hospital, Providence, RI
2012-Present Active Surgical Staff, The Miriam Hospital (TMH), Providence, RI
2013-Present Medical Director, Transfusion Free Medicine at Rhode Island Hospital, Providence, RI
2015-Present Medical Director, Surgical Intensive-Intermediate Care Unit at TMH, Providence, RI
2016-Present Medical Director, Trauma Intensive Care Unit at Rhode Island Hospital, Providence, RI
2016-Present Section Chief of Trauma in the Division of Trauma and Surgical Critical Care, Providence, RI
2017-2018 Vice Chair for the Committee on Trauma for the State of Rhode Island
2018-Present Chair for the Committee on Trauma for the State of Rhode Island
Other Experience and Professional Memberships
2012-2013 Member, American Society for Parenteral and Enteral Nutrition
2012-Present Councilman, Rhode Island Chapter, American College of Surgeons
2014-Present Member, Society for Critical Care Medicine
2015-Present Member, American College of Surgeons
2019 Member, American Association for the Surgery of Trauma
Honors
2007 Excellence in Teaching, Tufts Medical Center
2008 Excellence in Teaching, Tufts Medical Center
2009 Excellence in Teaching, Tufts Medical Center
2009 Deterling Award, Tufts Medical Center
2009 Administrative Chief Resident in Surgery, Tufts Medical Center
2010 Mary Ellen Mangano Award, Tufts Medical Center
2010 Outstanding Laparoscopic Resident Surgeon, Tufts Medical Center
2014 Outstanding Teacher Faculty Award, Alpert Medical School of Brown University, Department of Surgery
2015 Fellow, American College of Surgeons
2018 Dean’s Excellence in Teaching Award, Alpert Medical School of Brown University
C. Contributions to Science
1. Quality improvement in trauma resuscitation, post-traumatic care. As an attending trauma-critical care surgeon, I have undertaken work to review pre-trauma and pre-hospital factors which may influence trauma related outcomes following admission. Regarding initial presentation to the Emergency Department, I described best ways to determine the severity of injuries a patient has experience. Our findings have helped to streamline and triage trauma patients as well as efficiently utilize resources jupon patient’s hospital arrival. Ongoing work is focusing on developing and confirming scoring systems to eliminate both under and over triage of injured patients. The recent significant advances which have been made in the care of trauma patients have been based on a better and detailed understanding of injury pattern, etiologies and mechanisms. Regarding this, I described the effect of trauma patients presenting in a delayed fashion resulting in poor trauma outcomes. I noted that this effect was most seen when comparing elderly trauma patients who present delayed versus those who present in a timely fashion. Ongoing work is reviewing reasons why elderly patients delay seeking care, including potential social isolation or dementia. These findings are in keeping with our understanding that elderly patients have a limited physiologic reserve and delays in seeking care drains those reserves. Combined with this, I have been involved in understanding why pre-trauma health care insurance affects outcomes. In keeping with our division’s prior work on insurance and traumatic brain injury (TBI), I have noted that lack of health care insurance or being under-insured negatively increases the risk of infections, especially ICU related infections.
a. Roden-Foreman JW, Rapier NR, Foreman ML, Zagel AL, Sexton KW, Beck WC, McGraw C, Coniglio RA, Blackmore AR, Holzmacher J, Sarani B, Hess JC, Greenwell C, Adams CA, Lueckel SN, et al. Rethinking the definition of major trauma: The Need for Trauma Intervention outperforms Injury Severity Score and Revised Trauma Score in 38 adult and pediatric trauma centers. J Trauma Acute Care Surg, 2019 Sep;87(3):658-665. PMID: 31205214.
b. Kao MJ, Nunez H, Monaghan SF, Heffernan DS, Adams CA Jr, Lueckel SN, Stephen AH. Trauma patients who present in a delayed fashion: a unique and challenging population. J Surg Res. 2017 Feb;208:204-210. PMID: 27993211.
c. Sawhney JS, Stephen AH, Nunez H, Lueckel SN, Kheirbek T, Adams CA Jr, Cioffi WG, Heffernan DS. Impact of Type of Health Insurance on Infection Rates among Young Trauma Patients. Surg Infect (Larchmt). 2016 Oct 17(5):541-6. PMID: 27244084.
2. Improvement in trauma critical care. Pertaining to acute in-hospital care, I have applied my extensive clinical experience to both improving ICU care as well as better describing and understanding the nature of traumatic injuries as well as the role of optimizing ICU related trauma care. This has been encapsulated in my manuscript pertaining to the role of the critical care advances in acute care surgical patients as well as my manuscripts on both ventilator support and barotrauma as well as the importance of nutritional support among the critically ill. Furthermore, invasive monitoring of critically ill patients, essential to optimizing fluid balances and cardiovascular status, are a double-edged sword, and place patients at increased risk of infections. To this end, I was part of a nationwide analysis of aseptic techniques for placement of invasive monitoring. My work on ICU management has been coupled with my role in limiting excess blood and product transfusion working on the Transfusion-Free Medicine Committee in drafting protocols for trauma and surgical patients.
a. Cohen DM, Carino GP, Heffernan DS, Lueckel SN, Mazer J, Skierkowski D, Machan JT, Mermel LA, Levinson AT. Arterial Catheter use in the ICU: A National Survey of Antiseptic Technique and Perceived Infectious Risk. Crit Care Med. 2015 Nov;43(11):2346-53. PMID: 26262949.
b. Kao MJ, Nunez H, Monaghan SF, Heffernan DS, Adams CA Jr, Lueckel SN, Stephen AH. Trauma patients who present in a delayed fashion: a unique and challenging population. J Surg Res. 2017 Feb;208:204-210. PMID: 27993211.
c. Hall BM, Heffernan DS, Lueckel SN, Stephen AH, Kheirbek T, Connolly MD, Benoit E, Adams CA, Cioffi WG, Monaghan SM. Loss of Lymphocytes Can Predict Complications. Presented at American Association for the Surgery of Trauma, September 2019.
3. Reducing negative long-term sequelae of trauma. Pertaining to long term trauma outcomes, I have addressed the nursing home and long-term care facility needs, outcomes and areas for improvement for trauma patients. I have and continue to utilize the national federally driven Minimum Data Set (MDS) working on probabilistic matching of injured patients who transition to post-acute care. This has afforded me the opportunity to study large numbers of trauma patients across the United States. I have demonstrated that the number of trauma patients admitted to long term care following traumatic brain injury (TBI) has markedly increased over the past 10 years. Among these patients, the rate of dementia has progressively increased. However, fewer TBI patients required stays of 30 days or more and fewer patients require long term feeding tubes. Unfortunately, there is also a higher mortality and evidence of poor functional and cognitive improvement in this population. This work was coupled with the portfolio from my Master’s in Clinical and Translational Research at Brown University as I continue to focus on outcomes of trauma patients. Additionally, I have focused on helping patients and families transition towards comfort measures (CMO) and provided support for the families who absorb these traumas as well. My future work aims to address factors that will improve families’ ability to better care for trauma patients and make the most informed decisions for these patients, ultimately improving the care of the trauma patients.
a. Lueckel SN, Teno JM, Stephen Ah, Benoit E, Kheirbek T, Adams CA Jr, Cioffi WG, Thomas KS. The Population of Patients with Traumatic Brain Injury (TBI) in Skilled Nursing Facilities: A Decade of Change. J Head Trauma Rehabil, 2019 Jan/Feb;34(1):E39-45. PMID: 29863612. PMCID: PMC6274633 [Available on 2020-01-01].
b. Lueckel SN, Kosar CM, Teno JM, Monaghan SF, Heffernan DS, Cioffi WG, Thomas KS. Outcomes in Nursing Home Patients with Traumatic Brain Injury. Surgery, 2018 May 9. PMID: 29751966.
c. Lueckel SN, Stephen AH, Monaghan SF, Binder W, Adams CA. Predicting Outcomes of the Injured Brain. Rhode Island Medical Journal, accepted July 2019.
d. Tindal E, Heffernan DS, Lueckel SN. Adding Infectious Insult to Traumatic Injury in End-of-Life Decisions. Presented at Surgical Infection Society Annual Meeting, June 2019.
Complete List of Published Work: https://www.ncbi.nlm.nih.gov/myncbi/1HgMa3Hf0wj11R/bibliography/public/
D. Additional Information
Research Support
Ongoing Research Support
PCS-1511-32745 (O’Toole) 08/01/2017- 08/31/2020
Major Extremity Trauma Research Consortium (METRC), Patient-Centered Outcomes Research Institute (PCORI)
Prevention of Clots in Orthopedic Trauma (PREVENT CLOT): A Randomized Pragmatic Trial Comparing the Complications and Safety of Blood Clot Prevention Medicines Used in Orthopedic Trauma Patients
Goals of this project are to test the efficacy of Aspirin in traumatic clot prevention. My role has been to facilitate recruitment at our site at Rhode Island Hospital.
Role: Local Co-PI
PCORI-PFA-2017 (Gutman) 10/2018 – 09/2021
Patient-Centered Outcomes Research Institute (PCORI)
Improving CER/PCOR methods for analyzing linked data sources in the absence of unique identifier
My role on this project has been to provide the clinical expertise to appropriately apply these linked methods.
Role: Co-Investigator
R21AG059120 (Thomas) 09/01/2018 – 08/31/2020
NIH / NIA
Innovative approaches to examine post-acute care outcomes of older adults with traumatic brain injury
My role has been to provide the clinical perspective regarding the traumatic brain injury and its natural post-acute care prognosis.
Role: Co-Investigator
Clinical Research on Families Award (Lueckel) 10/1/2019 – 9/30/2020
Department of Behavioral Medicine
Minimizing the Traumatic Ripple Effect: An investigation into how families experience trauma
The goal in this project is to understand if and how family dynamics change when a family member has sustained trauma. My role has been to recruit, conduct and collect data.
Role: Principal Investigator
Thursday, October 22, 2020
3:30 PM – 3:47 PM EST