International trauma project set to reduce fatalities
Several of the world’s most renowned trauma teams, including Queen Mary University of London in partnership with The Royal London Hospital, are embarking on an extensive five-year project to investigate abnormal bleeding in trauma patients.
The project, which has just begun, will aim to develop international guidelines to treat abnormal bleeding (known as coagulopathy) in trauma patients. Death rates for trauma patients with coagulopathy are three to four times higher than other trauma patients.
The Queen Mary and Royal London trauma sciences team is part of the International Trauma Research Network (INTRN)* which has been awarded €5.88m from the European Union Framework Programme 7 (FP7) to better understand coagulopathy and work out how to quickly diagnose and treat the condition.
Karim Brohi, Professor of Trauma Sciences at Queen Mary University of London (Barts and The London School of Medicine and Dentistry) comments: “The award is a major investment in trauma research which will ultimately improve care for trauma patients. Although trauma remains one of the world’s biggest contributors to the global burden of disease, predominantly affecting young adults and children, medical research in the field has been lagging.
“This FP7 grant will go a long way towards helping improve the outcome for critically injured trauma patients. This research is expected to reduce trauma haemorrhage-related mortality by around 10%, as well as significantly reducing hospital and societal costs.”
Co-ordinated in Copenhagen, the research programme, entitled Targeted Action for Curing Trauma Induced Coagulopathy, or TACTIC, will specifically look at:
- Comparing coagulation across patients and outcomes in response to different existing blood transfusion strategies
- Specifying different disease profiles underlying trauma induced coagulopathy
- Developing personalised strategies for targeted blood transfusions
- Comparing existing practices with personalised, targeted treatment of trauma induced coagulopathy
- Delivering guidelines and support for the clinical management of bleeding associated with coagulation
Professor Pär I. Johansson, consultant at Rigshospitalet in Copenhagen, who is leading TACTIC, comments: "In analysing blood samples from 2,000 trauma patients, we expect to get a better understanding of why some trauma patients develop abnormal bleeding, and when intervention is appropriate in a course of treatment to avoid this. On the basis of this knowledge we will propose new methods of treating these patients.”
The FP7 grant complements last year’s £3m investment from Barts Charity in the Queen Mary-based Centre for Trauma Sciences. The Charity’s infrastructure award has enabled the centre, led by Professor Brohi, to expand its research efforts into the first two hours after injury – a critical period when around 50% of deaths from trauma occur – but is notoriously difficult for clinical research. The Centre for Trauma Sciences is one of just a handful of centres in the world with the capacity to conduct research within minutes of injury and follow-up patients for life.
Professor Brohi added: “As research allows us to understand more about the mechanisms underlying trauma there is huge potential to deliver innovations which will have a major impact on the survival and the quality of life of critically injured patients.
“However, as the system stands we are really close to the limit of what current clinical care can provide to trauma patients and without a significant improvement in the quality and depth of trauma research we will not be able to develop new treatments and drugs that can save many more lives.
“Even if trauma patients do survive, they can be left with permanent physical and mental disability which, for some patients, makes life almost unbearable. We need to find out more about how to give recovering patients the highest possible quality of life.”
What is trauma?
Trauma is the disease caused by physical injury. Trauma has only been called a “disease” since the 1970s. Although it seems strange at first, it is the correct term to use. Severe injury triggers a sequence of changes within the cells of the body and can lead to critical and disabling illness. Just like other diseases such as cancer, HIV and heart disease we need to understand these changes to improve survival and recovery.
What are the causes of trauma?
Severe injuries occur from a variety of different mechanisms. In the UK, the most common incidents are falls from height and collisions with motor vehicles either as drivers, passengers, pedestrians or cyclists. Trauma also occurs from injuries with weapons such as knives or guns. Unpredictable events like train crashes and natural disasters can injure many people at the same time.
How big is the problem?
Traumatic injury kills more people below the age of 45, than any other disease process. In England, major trauma accounts for 5,400 deaths per year. The Royal London Hospital admits around 2,200 trauma patients every year.
For every patient who dies several more become disabled and cannot return to work or conduct their normal daily activities.
The National Audit Office estimates that major trauma costs the NHS in England between £0.3 and £0.4billion a year in immediate treatment, with the cost of continued care, rehabilitation and support unknown. Annual lost economic output as a result of major trauma is believed to be up to £3.7billion (National Audit Office – Major trauma care in England, February 2010).
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