C4TS Newsletter www.c4ts.qmul.ac.uk Spring/Summer 2016 Issue 10 Welcome to the C4TS Spring/Summer 2016 newsletter. In this bumper edition, we announce the start of ORDIT, a UK wide study mapping the incidence of multiple organ dysfunction after traumatic injury. Karen Hoffman outlines her plans to establish the UK's first on-line supported self-management program for trauma survivors, and Ross Davenport discusses how a clinical trial to provide the blood product cryoprecipitate early in treating haemorrhaging trauma patients could save more lives. Finally, we report on the resounding success of our Trauma Survivors Day cyclethon - a good omen for our upcoming music festival fundraiser. Enjoy!
Organ Dysfunction in Trauma: ORDIT - a point prevalence study Background Multiple organ dysfunction syndrome (MODS) is an exaggerated systemic inflammatory response following major tissue trauma which results in vital organs suffering temporary or permanent damage. International reports suggest that MODS affects 1 in 3 severely injured patients. However our local trauma data reveals that the burden of MODS may be much higher, with almost 80% of critical care patients being affected. MODS typically develops within a day or two from injury, frequently involving respiratory and coagulation dysfunction. There appears to be two forms of MODS – one that resolves quickly within the early period of critical care or prolonged MODS, which lasts for a week or more, and is associated with high rates of infection, long hospital stays and mortality. Despite advances in initial trauma Centre for Trauma Sciences
Dr Elaine Cole (Principal Investigator ORDIT)
by Dr Elaine Cole (Principal Investigator)
management, with targeted early resuscitation and delivery of care in Major Trauma Centres, little is understood about the incidence, drivers and severity of MODS in the UK trauma population.
ORDIT ORDIT is a one month point prevalence study of all trauma patients admitted to UK Major Trauma Centre (MTC) adult critical care units. It began on 1st June and all UK MTCs are now recruiting patients into the study. The primary aim of the study is to understand how many trauma patients in the UK develop organ dysfunction, how severe it is and at what stage it occurs after their injury. Detailed clinical data is being collected during the patients critical care stay. Other objectives are to evaluate the relationships between MODS and other outcomes such as the rates
Newsletter Spring/Summer 2016
Figure 1 – the Sequential Organ Failure Assessment score is a key ORDIT measurement tool
and mode of mortality. Quality of life data (QoL) at 12 months post injury will also be collected by the C4TS research team.
Implications The study is the first major trauma study to involve all the UK MTCs. It will provide comprehensive baseline data to help us better understand this challenging adverse outcome and contribute to the development of new treatments. More information about ORDIT can be found here. 1
CRYOSTAT-2 By Dr Ross Davenport (Principal Investigator)
The bleeding problem Major haemorrhage is the most common preventable cause of death in the trauma population, with most deaths occurring within the first 6 hours after injury. As many as 4 in every 10 patients affected by severe trauma die from uncontrolled bleeding. C4TS research to date has shown that low fibrinogen levels on admission to hospital are predictors of early mortality in trauma patients. Fibrinogen is a protein essential for forming clots.
The cryoprecipitate potential Cryoprecipitate is a concentrated source of fibrinogen and is already used as a treatment for patients with major bleeding. However transfusion typically occurs late (3 hours or more) after arrival in the Emergency Department.
Self Management for Trauma By Dr Karen Hoffman Survivors (Research Fellow) AfterTrauma Many trauma survivors experience leaving hospital as 'like falling off a cliff'. There are very few supports in the community to help people with multiple injuries on their long and difficult recovery journeys. In April 2015, C4TS launched After Trauma , the UK's first website dedicated to providing information to help survivors of multiple traumatic injury, including links to useful organisations and survivor stories.
In 2013, C4TS undertook CRYOSTAT-1, a small study that found it was feasible to deliver cryoprecipitate to trauma patients within an hour of admission, and this appeared to reduce mortality. C4TS is now applying for funding from the National Institute for Health Research (NIHR) to carry out a large multi-centre Randomised Controlled Trial (RCT) to evaluate early cryoprecipitate in major traumatic haemorrhage (CRYOSTAT-2). Figure 2 – The AfterTrauma website home page
CRYOSTAT-2 If the grant is approved, the trial will test the effect of early cryoprecipitate (within 90 minutes of admission) compared to standard blood transfusion therapy, on 1542 severely bleeding trauma patients at all 22 Major Trauma Centres (MTCs) across England and Wales, starting early 2017. As principal investigator for the study, I hope we are able to report in the next newsletter that CRYOSTAT-2 will become a reality. Improved transfusion practices have the potential to save millions of lives globally. For more information, please feel free to contact me.
Centre for Trauma Sciences
Newsletter Spring/Summer 2016
In April this year, we received a grant from Barts Charity to help us improve the usefulness of AfterTrauma by using it to host an on-line supported Self-Management Program (SMP) for trauma survivors.
What is Supported Self Management? Supported self-management programs (SMP) aim to educate people about their health condition and care, motivate them to care for themselves in the best possible way (eg coaching, goal setting), and provide them with
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techniques and tools to enable them to do that (eg connecting with peers). There are many different models of SMPs, most of them for long term conditions such as chronic pain and diabetes. So far, there is only one on-line SMP set up specifically for survivors of multiple traumatic injuries, and that is Next Steps in America.
By patients, For patients The first step in setting up an on-line SMP here in the UK is to gather together a focus group of trauma survivors and start to work out what the content of a trauma specific SMP should be, and how can we make the best use of webbased technology to help survivors and their families improve their recovery experience.
On Wednesday 18th May, 83 riders hopped on static bikes in the Royal London Hospital foyer for a 12 hour cyclethon in honor of international Trauma Survivors Day. Clinicians gave up their lunch breaks or cycled before they started their shifts or on their way home. They raised ÂŁ1730 for Barts Charity's trauma appeal, and a great time was had by all!
We have a great group of former trauma patients who have offered to co-produce the program so far, but the more survivor input, the better. So please do drop us a line if you'd like to participate or just want to know more information. Grace (L) & Shan (R) are just two of the amazing trauma survivors who have volunteered to help shape the AfterTrauma selfmanagement program
TRAUMA TALKS!
Every fortnight at the Royal London Hospital, resident and visiting trauma clinicians give
From October 13th - 15th, C4TS is hosting a meeting of international experts in the field of poly trauma rehabilitation. The aim of the conference is to reach a consensus on the most important categories of the International Classification of Function, Disability and Health (ICF) relevant to trauma rehabilitation globally. It will represent a milestone in measuring outcomes for trauma patients. For more information, contact Dr Karen Hoffman. On Saturday 19th November, Barts Charity and C4TS will be hosting Transformations, the UK's first music festival celebrating trauma survival. The venue is the very cool and very disability friendly Village Underground in London's East End. Watch out for the feature in the next newsletter, or for more information in the meantime contact Nicole Skeltys.
presentations on all aspects of trauma care. You can watch the Trauma Talks videos on the C4TS Vimeo channel. Follow us so you don’t miss an
You can contact us via our website, and follow us on Twitter @CommsC4TS. We’d love to hear from you!
episode!
Centre for Trauma Sciences
Newsletter Spring/Summer 2016
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