C4TS WINTER 2013 NEWSLETTER
Issue 1
C4TS
Winter 2013 newsletter
WELCOME
Welcome to the first Barts Centre for Trauma Sciences (C4TS) newsletter. These regular updates will keep you informed of our research and educational achievements and goals, as well as fostering local and international collaboration within injuries research. In this inaugural edition we provide an overview of the virtual Centre’s inception and structure, and our overall ambitions. Having read about some of the latest findings from the trauma research themes, you can also delve into more detail through our organisational website (www.C4TS.qmul.ac.uk) and keep up to date by following us on Twitter (@BartsC4TS).
C4TS – one year on THE NEED Worldwide trauma is a leading cause of death and disability in all age groups and is by far the biggest killer of children and young adults. Despite modern medical care and increasing establishment of specialist trauma centres within coordinated regional trauma systems, outcomes for critically injured trauma patients remain poor. Severe bleeding, brain injury and organ failure are associated with high mortality, major complications and extremely high levels of permanent physical and mental disability.
Karim Brohi (Centre Lead)
by Vijay Patel (Centre Administrator)
Translational research in trauma sciences has been limited by the absence of an overall strategy for collaboration, inter-disciplinary integrated research infrastructure and impactful dissemination.
Now in the second of a 3-year award, the C4TS has been developing key infra-structure and research expertise to lead global networks to achieve ‘Total translation of trauma research into practice and into policy’.
OUR AMBITION QMUL has significant expertise in discovery science related to injury. In October 2012, Barts and The London Charity (BtLC) invested £3million to establish the Barts Centre for Trauma Sciences (C4TS) to strengthen the bonds between these groups and maximise the impact of translational research for trauma patient benefit.
Underpinned by four translational research cores as the basis for this total translation framework (see figure below), the virtual centre has three trauma research themes in areas with the highest burden of namely death and disability: haemorrhage, brain & spinal cord injury and multiple organ failure. (Find out more at our website)
C4TS WINTER 2013 NEWSLETTER | Issue 1
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Research Project Spotlight Traumatic Coagulopathy & Massive Transfusion - “Improving Outcomes & Saving Blood”
Funded by the National Institute of Health Research, Barts C4TS has just completed a 5-year, £2M program of research. The multi-component study entitled “Traumatic Coagulopathy and Massive Transfusion” was the first of its kind to describe current UK practice in terms of incidence of transfusion for trauma patients, their outcomes, the demand for blood components and treatment costs.
BACKGROUND Uncontrolled bleeding is responsible for 40% of all trauma fatalities, with many severely injured patients developing a clotting abnormality, termed Coagulopathy, within minutes of injury. This exacerbates lifethreatening bleeding and is associated with significantly poorer outcomes (i.e. four-fold increase in mortality, worse organ injury) and higher blood transfusion needs. Current treatment of uncontrolled haemorrhage in trauma comprises the early, unguided, transfusion of red blood cells & blood components preassembled as ‘Trauma Packs’. OBJECTIVES The multi-disciplinary, collaborative program entailed six cohesive aims: 1. 2. 3. 4. 5. 6.
EVIDENCE EPIDEMIOLOGY DIAGNOSIS TREATMENT DISASTER HEALTH ECONOMICS
METHODOLOGY Aim 1 (Evidence) entailed systematic review of the literature to define baseline knowledge of the diagnosis and management of Acute Traumatic Coagulaopthy (ATC). The Aim2 study (2009-11) recruited 479 adult bleeding trauma patients from 22 trauma hospitals in England and Wales to determine the incidence of transfusion trauma (Epidemiology) existing patterns of practice and estimate national health care costs. In Aim 3, existing point of care assays and Rotational Thromboelastometry (ROTEM®) were used to analyse 810 trauma patient’s functional clotting response to both severe injury and transfusion. This aim explored the ROTEM®’s potential to diagnose ATC and predict transfusion need. Aim 4 (Treatment) employed a subgroup of 106 trauma patients who were actively bleeding and received 4 units of red blood cells within 12 hour of admission. This cohort was studied to determine which test(s), clinical parameters and biomarkers would be best if used to guide therapy.
Simon Eaglestone (Project Coordinator) By
Blood is a valuable and limited resource at all times, but especially so during mass casualty events (MCEs). In Aim 5, the published evidence on MCEs from the past 100 years was utilized to develop a computer simulation model (below) of hospital demand for blood products and transfusion services in disasters.
Aim 6 comprised health economic analysis and cost modelling which was interwoven with many of the program’s specific parts. The complementary program aims were designed to progressively determine the existing evidence base for the optimal role of transfusion in improving outcome for severely injured trauma patients and to enable the diagnosis and guided treatment of coagulopathic bleeding.
KEY FINDINGS
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Approximately 7800 trauma patients in England and Wales require life-saving transfusion every year, at a total direct NHS cost of £168 million per annum
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ATC was found to have a specific ROTEM® signature that can be detected within five minutes and alert clinicians to a patient at greater risk of major bleeding
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Current transfusion practice in trauma does not achieve the early balanced coadministration of plasma and red blood cells, nor does it correct coagulopathy
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Transfusion therapy for coagulopathic bleeding and patient outcomes might be enhanced by greater focus on early administration of clotting substrate (i.e. Fibrinogen) and anti-fibrinolytic administration (i.e. inhibition of clot lysis).
C4TS WINTER 2013 NEWSLETTER | Issue 1
Trauma Education
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NEW RESEARCH STAFF
Complementing the promotion of interdisciplinary collaborative research, C4TS also focuses on the continued development and delivery of education and policy initiatives for the global enhancement of trauma patient care. This entails many different arms including our international distance-learning courses in MSc Trauma Sciences, local training for civilian and military medical personnel and regular participation in public science exhibitions and schools career fairs. (Left – School children get to be trauma surgeons for the day)
Wider Engagement As a virtual centre, a key goal of Barts C4TS is to bring together and promote the broad population and clinical research expertise in injury research from across the School of Medicine & Dentistry (SMD), Queen Mary University of London which includes: •
Blizard Institute - Brain and Spinal Cord Injury (Adina Michael-Titus) - Immune Systems (Dan Pennington)
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William Harvey Research Institute - Shock and Organ Protection (Chris Thiemermann) - Inflammation and Patient Outcomes (Michael O’Dwyer) - Intensive Care Medicine (Rupert Pearse, Charles Hinds) - Micro vascular Biology (Sussan Nourshargh)
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Centre for Primary Care and Public Health - Public Health and Policy (Allyson Pollock)
C4TS’s strategic aims also encompass an ongoing program of engagement for young people and their families to help them understand, in a tangible way, the reality and increasing risk of traumatic injury and “Trauma surgeons warning of to highlight the vital role that scientific research plays 'butchery' of gang violence leaves in the continuous improvement of medical practice. them terrified” 4th November 2013
Whilst there are challenges facing public engagement in trauma research (e.g. consenting patients in times of extreme physical and mental stress), C4TS is working closely with Barts and The London Charity and SMD’s Press Officers to maximise the impact of our ongoing campaign to promote increased awareness of Trauma and both the personal and societal impact it has. Left - Recent newspaper article on interpersonal violence. Visit the London Evening Standard website to view the full article.
In its first year, C4TS has attracted 15 new members of academic, professional and research staff including: (Above - starting from the top)
Ping Yip, Brain & Spinal Cord Injury “My current role involves fundamental research in traumatic brain injury and spinal cord injury. I conduct in vivo research using techniques such as histology, molecular biology and cell culture to investigate neurotrauma and mechanisms of injury, tissue damage and regeneration”.
Lewis Gall, Bleeding & Coagulation “My clinical research focuses on patients with Acute Coagulopathy of Trauma, with the aim of better understanding its mechanisms and how to improve the effectiveness of its treatment”.
Hew Torrance, Organ Failure & Protection “I am exploring the body’s immediate response to traumatic injury and how early changes in the immune system affects outcomes of those patients admitted to the critical care unit”.
ENGAGE ENGAGEWITH WITHUS US
ANNOUNCEMENTS
We would welcome any suggestions that you might have for collaboration, whether in We would welcome any suggestions that you might have for collaboration, whether trauma research or education. Please feel free to contact us via the website in trauma research or education. Please feel free to contact us via the website (www.C4TS.qmul.ac.uk) and via Twitter (@BartsC4TS). (www.C4TS.qmul.ac.uk) and via Twitter (@BartsC4TS).
BtLC Cycling and Trauma Seminar st chaired by Jon Show 31 January 2014 Click here for more information.