C4TS SPRING 2014 NEWSLETTER
Issue 2
2
C4TS
SPRING 2014 newsletter
WELCOME
Spring has finally arrived with the start of 2014 bringing a wave of media focus on cyclist injuries and the work of the London’s pre-hospital and specialist trauma centres. A key factor in the continuous provision of world-leading injury care within our Capital is the research and educational activity of the Barts Centre for Trauma Sciences (C4TS). In this Newsletter edition we provide an overview of the challenges of conducting injuries research, results of a study assessing the impact of implementing London’s regional trauma system and feedback on the discussion and outcomes of the recent Cycling and Trauma Seminar, organised by Barts and The London Charity and chaired by John Snow.
Trauma Call
By
Claire Rourke (Clinical Trials Coordinator)
THE NEED TO STUDY TRAUMA Traumatic injury is responsible for a large proportion of the world's burden of disease, with over 5 million deaths annually and an ever increasing economic and societal impact.
To understand the body’s immediate reaction to both traumatic injury and treatment itself requires research to be conducted by dedicated staff working alongside but independent of the trauma team providing care.
Trauma is a healthcare field in which the uptake of new approaches can have an immediate and significant effect on patient outcomes, both in terms of survival and quality of life. To achieve evidence-based changes in practice that optimise patient outcome, healthcare delivery and the allocation of resources requires significant research investment, beyond that of clinical audit.
CONDUCTING RESEARCH IN THE EMERGENCY ENVIRONMENT Informed consent is a process for gaining permission before conducting research involving any person. Most potential trauma study participants will be incapacitated upon arrival at the Emergency Department. Neither they nor their relatives will be able to provide informed consent in this early stressful period. Most commonly the trauma team leader will act as a legally authorized representative, providing informed consent so enabling emergency care research to begin. However over time, there is a hierarchy of consenting that then seeks permission from the patient’s relatives and ultimately the subject themselves to continue.
Acute injuries research is challenging. By its very nature trauma is unpredictable and comprises many different types and mechanisms of injury. The patients to be studied present with critical injuries that require immediate, life- and limbsaving treatment by large specialist trauma teams.
Simon Eaglestone (Head of Operations)
Unlike most other fields of medicine trauma research requires a means to capture the unpredictable arrival of injured patients, often at night. Always having research staff available to attend a trauma call is expensive and requires close working and engagement with the trauma team.
ENSURING ROBUST RESEARCH METHODS & INFRASTRUCTURE Our trauma research activities span the whole patient journey, from injury to convalescence, and comprise multiple disciplines (e.g. emergency medicine, surgery, intensive care). This necessitates effective working across departments and with other hospitals to increase the diversity and rate of trauma patient recruitment. Whilst trauma research is difficult, we and our partner hospitals use the same clear and visible protocols and forms to ensure the robust collection, sharing and analysis of patient data and samples. Underlying all of our research activity is the drive to ensure the conduct of the highest quality research methodology, practice and governance to ensure the protection of patient confidentially and rights and the evidence-based optimisation of trauma care and patient outcomes. Click here to find out more about our research and clinical trials activities.
C4TS SPRING 2014 NEWSLETTER | Issue 2
2
Research Project Spotlight “Evaluation of London Trauma System”
▪ Assess the overall quality of trauma care and delivery in London against the original NCEPOD findings ▪ Examine the effect that regionalised care has on access for injured patients and the need for secondary transfers ▪ Identify improvements in processes of care, time to intervention and seniority of treating clinicians ▪ Determine if maturation of the LTS has led to mortality improvements
BACKGROUND Results from this population wide analysis directed the implementation of the UK’s first regional trauma system, which went live in London back in April 2010. Regional trauma systems are reported to improve outcomes following injury, with preventable mortality rates being decreased as the system matures. Inclusive trauma systems organise resources to deliver optimum care in the most appropriate facility, within efficient time points. Major Trauma Centres (MTCs) are specialty hospitals responsible for the care of the most severely injured patients. The London Trauma System (LTS) is divided into four geographical networks, each with its own MTC, covering a total population in excess of 10 million.
METHODOLOGY ELoTS utilised the core methodology as described in the NCEPOD report. During a three month period (Feb to Apr 2013), all severely injured trauma patients were identified prospectively by nominated contacts within each of the four London trauma networks. Anonymised copies were made of the case notes from the first 72hours of their in-patient stay. An assessment form comprising the same NCEPOD quantitative and qualitative measures was also completed for each patient.
Each set of anonymised case notes and assessment forms was appraised by a multidisciplinary group of independent experts and peer reviewers. The assessors used quality performance and care indicators derived from the NECPOD study to rate patient management. RESULTS Figure 1: Quality of care 80
Percentage patients
Click here to access the original NCEPOD report from 2007:
AIMS The key objectives of ELoTS were to:
70 60 50 40
NCEPOD 2007
30
ELoTS 2013
20 10 0 Good care
Needs Less than improvement satisfactory
Figure 2: Mortality 35
Percentage mortality
Trauma is a leading cause of morbidity and mortality, responsible for over 7000 deaths each year in the UK. In 2007 the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) published ‘Trauma: Who Cares?’ reporting deficiencies in quality and processes of care for 60% of severely injured patients in the UK.
By Elaine Cole (Project Coordinator)
30 25 20
NCEPOD 2007
15
ELoTS 2013
10 5 0 All deaths
Critical injury
KEY FINDINGS
•
321 patients were recruited in the ELoTS study period with comparable age, gender and injury severity to the original NCEPOD patients
•
More patients received “good care” following the implementation of the London Trauma System in 2010 (Figure 1)
•
The inclusive London Trauma System has resulted in improved access to specialist care and timely early management. These process improvements are associated with overall mortality benefits for severely injured patients (Figure 2)
C4TS SPRING 2014 NEWSLETTER | Issue 2
Trauma Education
3
NEW RESEARCH STAFF
In 2012 we launched the first international distancelearning Masters options in Trauma Sciences, with a Military and Austere focused option. (Click here for further details). C4TS is committed to development and delivery of education and policy initiatives for the global enhancement of trauma patient care. This September sees the launch our new MSc course in Orthopaedic Trauma Sciences. This will enable the strategic growth of our MSc student numbers and further the quality and breadth of our global trauma education options.
Wider Engagement On Friday 31st January Barts and The London Charity, in partnership with C4TS, held a Cycling and Trauma Seminar. Chaired by Jon Show, the seminar asked “Can advances in medicine and research at Barts Health impact the number of seriously injured people from cycling incidents?”
Now in its second year, the C4TS continues to attract key research staff across a broad range of injury disciplines: (Above - starting from the top)
Miguel Burguillos Brain & Spinal Cord Injury
Barts Charity and C4TS are in the unique position to raise funds that can support the immediate implementation and longer-term development of innovative strategies for enhancing injury prevention, emergency care and trauma patient outcomes. This topical seminar brought together prominent clinicians, researchers and thought-leaders enabling us to explore the impact that Barts Charity and the C4TS can have on reducing deaths and cycling-related injury in London, with the implications for all UK road users. Click here to find out more and to watch video recordings of the presentations.
“I am working with patient samples and models of trauma to understand mechanisms of neuroinflammation, with a particular focus in the inflammatory response induced by Traumatic Brain Injury”.
Emma-Jane Mallas Outcomes “With a background in Psychiatric Research, I now collect data from trauma patients during their stay in hospital and conduct long term follow-up assessments, regarding physical recovery, mental health and quality of life”.
Diana Smith Public & Policy ANNOUNCEMENTS
C4TS’s strategic aims include a programme of education for young people and families to help them understand in a tangible way the reality and risk of traumatic injury. ENGAGE WITH US
On Tuesday 1st July, members of the Centre will be presenting an exhibit at The Big Bang South East Fair in Crawley. We would welcome any suggestions that you might have for collaboration, whether in research or Please feel free to contact us via the website Fortrauma more information clickeducation. here. (www.C4TS.qmul.ac.uk) and via Twitter (@BartsC4TS).
“I trained in geography with a focus on public health. I’m working on several projects which assess the relationship between local environments, populations and incidence of injury or ill health (e.g. cycling-related injuries)”
ENGAGE WITH US
Please do connect with us via our website (www.C4TS.qmul.ac.uk) and via Twitter (@BartsC4TS).