Systematic Molecular Phenotyping: A Path Toward Precision Emergency Medicine?
Precision medicine is an emerging approach to disease treatment and prevention that considers variability in patient genes, environment, and lifestyle. However, little has been written about how such research impacts emergency care. Recent advances in analytical techniques have made it possible to characterize patients in a more comprehensive and sophisticated fashion at the molecular level, promising highly individualized diagnosis and treatment. Among these techniques are various systematic molecular phenotyping analyses (e.g., genomics, transcriptomics, proteomics, and metabolomics). Although a number of emergency physicians use such techniques in their research, widespread discussion of these approaches has been lacking in the emergency care literature and many emergency physicians may be unfamiliar with them. In this article, we briefly review the underpinnings of such studies, note how they already impact acute care, discuss areas in which they might soon be applied, and identify challenges in translation to the emergency department (ED). While such techniques hold much promise, it is unclear whether the obstacles to translating their findings to the ED will be overcome in the near future. Such obstacles include validation, cost, turnaround time, user interface, decision support, standardization, and adoption by end-users.
The Division of Emergency Medicine, Duke University, Durham, NC. alexander.limkakeng@duke.edu.
Alexander T
AT
Limkakeng
The Department of Emergency Medicine, Division of Medical Toxicology, University of Colorado-Denver, Aurora, CO.|The Rocky Mountain Poison & Drug Center Denver Health & Hospital Authority, Denver, CO.
Andrew A
AA
Monte
The Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Christopher
C
Kabrhel
The Department of Emergency Medicine, University of Mississippi, Jackson, MS.
Michael
M
Puskarich
The Department of Emergency Medicine, Washington University, St. Louis, MO.
Laura
L
Heitsch
The Emergency Medicine Service, Durham Veteran's Affairs Medical Center, Durham, NC.|The Center for Applied Genomics & Precision Medicine and Division of Infectious Diseases & International Health, Department of Medicine, Duke University, Durham, NC.
Ephraim L
EL
Tsalik
The Department of Emergency Medicine and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Nathan I
NI
Shapiro
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D004635:Emergency Medicine / Q000379:methods / Q000639:trends*; D004636:Emergency Service, Hospital / Q000639:trends*; D006801:Humans; D008297:Male; D055432:Metabolomics; D010641:Phenotype; D057285:Precision Medicine / Q000639:trends*
D015415:Biomarkers