Through her years of work on trauma care, Johns Hopkins researcher Ellen MacKenzie has carved out a unique perch at the intersection of military and civilian health issues. From this vantage, she’s been able to appreciate how the two worlds can work together to improve care and quality of life for all injured patients.
“Lessons can be learned, then transferred,” MacKenzie says of the collaborations and discoveries coming out of METRC, the national research consortium she heads. “We have military and civilian providers learning together every day, and their work will benefit patients now and well into the future.”
METRC, which stands for Major Extremity Trauma and Rehabilitation Consortium, brings together over 50 trauma centers from across the U.S. together with the major military medical facilities to develop best practices for treating serious limb injuries, whether sustained in combat or everyday civilian life. The consortium launched in 2009 with Johns Hopkins Bloomberg School of Public Health as its coordinating center.
For MacKenzie, directing this consortium has been a natural progression after decades of research on injuries and their consequences, including groundbreaking studies on limb trauma that continue to guide the orthopaedics field. In 2012, the CDC honored her as one of 20 visionaries who have made a transformative effect on injury prevention and control.
Named a Bloomberg Distinguished Professor in 2017, MacKenzie is working with colleagues to establish a new research center focused on musculoskeletal injuries and recovery, and working more broadly to promote an environment for musculoskeletal care where “evidence continually informs practice and practice informs evidence.” She continues to teach and research with the Department of Health Policy and Management at the Bloomberg School—a department she chaired for 11 years—while building deeper connections with the School of Medicine.
MacKenzie’s niche in trauma care can be traced back to her foundational interest in numbers. The Long Island native majored in mathematics at Douglass College before diving into the world of biostatistics as a PhD student then faculty member at Johns Hopkins in the late 1970s.
As a young biostatistician working on several trauma-related projects, MacKenzie noted the lack of data on long-term outcomes for injured patients—which ultimately led to several studies that would change how surgeons think about successful recovery.
“No longer is it good enough to heal the bone—the real success comes when patients are returned to a productive and satisfying life,” MacKenzie says.
These lessons were underscored in a major NIH-funded study in which MacKenzie and colleagues followed 600 trauma survivors at multiple treatment centers to determine whether and when it’s best to amputate or reconstruct a very severely injured leg. Their discovery was surprising: Amputees seemed to fare just as well long-term as patients whose limbs were salvaged.
“We had orthopedic surgeons saying, ‘This can’t be true, there must be a difference!’” MacKenzie recalls. But the study, known as LEAP, also concluded that the amputation vs. limb salvage issue was less critical for recovery success than psychological factors—like self-efficacy, social support, and early signs of depression and anxiety.
To actively address these issues, MacKenzie started working more closely with rehabilitation psychologists and trauma patients to develop new types of interventions. Together with Johns Hopkins colleague Stephen Wegener, she helped create PALS, a self-management program for amputees, then NextSteps, an online program more broadly addressing the concerns of trauma survivors. The latter is now part of the Trauma Survivors Network that MacKenzie and colleagues developed with the American Trauma Society.
But as the LEAP findings continued to make waves over the years—yielding over 35 scientific publications and earning MacKenzie’s team an award from the American Academy of Orthopaedic Surgeons—the military took interest. A new study focusing specifically on military patients turned up contradictory new evidence: finding amputees faring better in recovery than veterans with salvaged limbs.
That study ultimately formed the foundation for METRC—which, under MacKenzie’s leadership, has garnered over $100 million in grant funding from the Department of Defense and other sources, and is now coordinating over 20 research projects. The research spans topics across the continuum of injury care, including preventing infection, reducing post-traumatic stress, and optimizing physical therapy. One study, the Trauma Collaborative Care Intervention, builds off the early work of LEAP and NextSteps to motivate patients to engage early in self-managing their recovery.
MacKenzie describes the consortium’s approach as cross-disciplinary even beyond the military and civilian overlap. “We’re working with orthopaedic surgeons, rehabilitation specialists, statisticians, epidemiologists…” she rattles off. “The strength of the work we’ve done is bringing those teams together.”
In addition to her work on limb trauma, MacKenzie—a former director of the Johns Hopkins Center for Injury Research and Policy—is known for co-authoring The Cost of Injury in the United States (1989), a work that helped define injury as a major public health problem. She also steered a major national study showing better survival outcomes from trauma centers vs. non-trauma centers, highlighting barriers to access to specialized care.