M4 Scarlett Tohme Designs Study to Examine Risk Factors for Deep Vein Thrombosis at Richmond University Medical Center
Research examines the risk factors that lead patients to develop deep vein thromboses in their upper extremities
With plans to pursue a career in surgery, Scarlett Tohme, SOM Class of 2021, made a point to seek out opportunities to conduct research with the trauma surgery department after completing her recent obstetrics and gynecology rotation at Richmond University Medical Center (RUMC), which ultimately resulted in her designing and leading a research project into the risks factors for deep vein thrombosis. The research study, which was conducted at RUMC during the spring and summer of 2020, has now been submitted for publication to the Journal of Vascular Surgery: Venous and Lymphatic Disorders.
“I believe that in order to be a successful physician, it is important to not only gain knowledge and skills but also share what I learn with others through research and mentorship,” says Ms. Tohme, who reached out to Nisha Lakhi, M.D., associate professor of obstetrics and gynecology and the assistant clerkship director at RUMC, about how she could participate in research. “Dr. Lakhi’s dedication to medical education is undeniable and her commitment to supporting medical students in any and every aspect of their medical education is incredible. As part of her research role at RUMC, she also works with the trauma surgery department on research projects to help maintain RUMC’s Level I Trauma Center status.
For her research, Ms. Tohme chose to examine the risk factors that lead patients to develop deep vein thromboses in their upper extremities. “The medical community is aware of the dangers of blood clots in the legs, and how they can cause significant heart and lung issues and can even lead to fatal outcomes if not caught early and treated appropriately,” she says. “Yet while there is a vast amount of information on what risk factors lead to blood clots in the deep veins of the legs, how to treat them and how to adequately prevent them, what is not as well-known is the particular risk factors that may affect how blood clots can develop in the deep veins of the arms in patients.”
Over 1,000 records of patients who had received ultrasound doppler studies from 2014 to 2020 were examined for the study. “One question the team at RUMC asked was if platelet levels had any influence on the development of blood clots, since it was known that higher levels of platelets led to higher risks for blood clots to form,” says Ms. Tohme. “Doppler studies are highly sensitive and specific in the diagnosis of deep vein thrombosis, and it was the most accurate way that we would be able to analyze the data.”
In examining the data, the team also looked at any relationship between gender, age, race, length of stay in the hospital, insertion of various catheters, or past medical history of heart disease, cancer, high blood pressure, kidney disease, diabetes, lung disease, history of implanted pacemakers and platelet levels at the time of the doppler studies.
According to Ms. Tohme, “It was interesting that while we saw no relationship between demographics and the incidence of deep vein thrombosis in patient population at RUMC, we did see that patients who had central venous catheters and/or peripherally inserted central catheters had the highest incidence of upper extremity deep vein thrombosis. In addition, patients who had medical histories of hypertension, kidney disease and cancer also has significantly higher incidences compared to the other risk factors. We also did not see any correlation between platelet level and the diagnosis of deep vein thrombosis.”
“These findings are important as it will help physicians and health care professionals to recognize risk factors for upper extremity deep vein thrombosis and to be cognizant of how deep vein thromboses may present differently compared to the well-known and thoroughly studied lower extremity deep vein thrombosis. This will allow health care providers at centers, such as RUMC’s Level I Trauma Center, to make efficient and accurate diagnoses and be accurately guided to proper and safe treatments and management.”
Overall, Ms. Tohme describes conducting the project extremely rewarding. “I was able to work with like-minded individuals to contribute to the advancement of medicine, where we look to find more effective and safer treatments to all patients. In addition, this project was also a wonderful opportunity to work with my classmates, Kyle Mobbs, SOM Class of 2021 and Aparna Vancheswaran, SOM Class of 2021. Our work together exemplifies the collective support of the NYMC student body, where we work together to accomplish goals. In addition, I am from Staten Island, having grown up on the Island and was even born at RUMC! It was so rewarding o give back to my hometown and help improve healthcare for my neighbors through this research.”