Randi Smith and Deepika Koganti partner on two trauma-related grants

March 2021

Randi Smith and Deppika Koganti

Randi Smith, Deepika Koganti

Randi N. Smith, MD, MPH, and Deepika Koganti, MD, both Emory trauma surgeons, emergency/elective general surgeons, and surgical critical care intensivists based at Grady Memorial Hospital, will be partnering on two grants. Dr. Smith will be principal investigator and Dr. Koganti co-principal investigator of a grant from the Atlanta Global Research and Education Collaborative (AGREC). The two physician-researchers will also have reversed roles on a Halle Institute for Global Research at Emory and University of Witwatersrand Collaborative Research Grant.

For the latter collaborative grant, Drs. Koganti and Smith will work with researchers at the University of Witwatersrand (Wits) in Johannesburg, South Africa, on the evaluation of two different trauma and acute care surgery service models to determine optimal global trauma and emergency surgery care. One model will be represented by the combined trauma and acute care surgery service at Grady Memorial Hospital, and the other by the separation of the two services in use at Chris Hani Baragwanath Academic Hospital (CHBAH) and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), both academic hospitals affiliated with Wits.

"Conditions requiring surgical care account for almost one-third of deaths across the globe, with trauma and acute care surgery patients making up the majority of this group," says Dr. Koganti. "All trauma and acute care surgeons focus on life-saving interventions, but we function in systems specific to our institutions. It behooves us to identify whether one system works better than the other in improving management and outcomes. Answering this question could change frameworks worldwide and address challenges surrounding the immense global burden of trauma and emergency general surgery."

The three high-volume, urban services will provide ample data for analysis and comparison. CHBAH is the largest hospital in the Southern Hemisphere and the third largest hospital in the world, CMJAH has one of the longest-standing trauma units in South Africa, and Grady's Level 1 trauma center is part of the largest public hospital-based healthcare system in the southeastern United States. The research team has chosen to focus on two of the most common injury types seen by trauma and emergency general surgery physicians: gunshot wounds and acute appendicitis.

With the support of the AGREC award, Drs. Smith and Koganti will lead a team of Emory and Georgia State University clinicians and academics as well as Atlanta community leaders in adapting an evidence-based trauma intervention, Stop the Bleed (STB), for culturally and linguistically diverse communities.

Local studies conducted by Dr. Smith and national investigations involving migrant, ethnic minority, refugee resettlement, and limited English proficient (LEP) communities have found that cultural and language discordance exacerbate the challenges these groups face in accessing preventive and emergency healthcare, and that the implementation of such health interventions as STB that could lessen the impact of these disparities are often hampered by language barriers. At Grady alone, interpreter services are used for numerous languages, including Arabic, Somali, Burmese, Amharic, Bengali, Nepali, Haitian Creole, Hindi, and Korean.

"As trauma physicians at Grady, we regularly see how the well documented rise in rates of trauma including violence during the pandemic has affected the vulnerable and underserved populations we serve, including refugee and immigrant communities," says Dr. Smith. "STB trains lay people in recommended response and bleeding control protocol before first responders arrive, and could help empower these people to contribute to safeguarding their communities, put them on the road to lessening disparities, and save lives. But, this critical training is only available in English and Spanish."

Drs. Smith, Koganti, and their diverse team propose to adapt the STB curriculum so that it is culturally and linguistically appropriate to deliver to speakers of Somali, Burmese, and Arabic, all languages spoken by a majority of the refugee, LEP residents in Clarkston, Georgia. They will then assess the revised delivery of the STB course to this population.