The Centre for Trauma Sciences – part of the Centre for Neuroscience, Surgery and Trauma at the Blizard Institute – conducts research across all aspects of the severely injured patient's journey, from pre-hospital care to rehabilitation outcomes.
To date, our highest impact research has been into the acute response to injury, particularly discoveries and improvements in the care of severely bleeding patients. We conduct this work in the Royal London Major Trauma Centre, Europe's busiest trauma centre, and the Blizard Institute's world class laboratory facilities.
A recent study from the Centre for Trauma Sciences including Dr Elaine Cole and Professor Karim Brohi looked at data from 1,169 patients treated between 2008 and 2017. Researchers found that thanks to trauma interventions informed by their research and adaptations to the Code Red protocol over time, there were 40% fewer patients bleeding to death. They wanted to see how their new approaches to diagnose and treat blood clotting problems affected the survival rates of the most critically injured patients. One of these changes was trauma teams using only red blood cell transfusions and clotting components derived from blood, instead of giving clear fluid infusions to patients while they were bleeding. They also began to deliver blood to patients before they even reached hospital. New devices to diagnose blood clotting problems at the patient bedside were introduced, allowing patient care to be individualised in real-time. In 2008, 48% of critically bleeding trauma patients died in hospital, a proportion which had been reduced to 27% by 2017.
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In 2017, the Centre for Trauma Sciences (C4TS) and NHS Blood & Transplant were awarded £2.4m from the National Institute for Health Research and Barts Charity to carry out a large multi-centre clinical trial called CRYOSTAT-2 to evaluate a new treatment in major traumatic haemorrhage. The trial aims to investigate whether more lives can be saved through the early delivery of cryoprecipitate - a concentrated source of fibrinogen, which is a protein found in the blood that helps stop bleeding by forming blood clots. Cryoprecipitate is already used as a treatment for patients with major bleeding, however, transfusion typically occurs late (three hours or more) after arrival in the Emergency Department. CRYOSTAT-2 will instead look into the effect of delivering cryoprecipitate within 90 minutes of admission. C4TS research to date has shown that low fibrinogen levels on admission to hospital are predictors of early mortality in trauma patients. This is the first national transfusion study in the UK since trauma networks were established in England and Wales.
A team of researchers from the Blizard Institute’s Centre for Trauma Sciences (C4TS) and Centre for Immunobiology recently had research published in the journal PNAS which found that histones – small proteins released by the injured tissues of trauma patients – punch holes in platelets causing them to swell into balloon structures. The team wanted to investigate what happens to platelets after traumatic injury. They found that after injury, platelets become less able to stick together but they do appear to be activated. The surface of these platelet balloons support blood clot formation, and microparticles released from balloons then stick to white blood cells and may alter the response of the immune system. Their work provides important information on how and why platelet function changes after traumatic injury. It also highlights a link between platelet function and the immune system, which will form the basis for ongoing research.