Barts c4ts autumn 2015 newsletter

C4TS Newsletter Autumn 2015 Issue 8 Welcome to the C4TS Autumn 2015 newsletter. In this edition, we outline how our research into the diagnosis and correction of abnormal clotting has progressed to a European multicentre clinical trial (iTACTIC). We highlight the investment we are making in future trauma clinicians through our expanding educational programs. Keeping an emphasis on a global outreach, we also explain more about our recent awards from the World Health Organisation (WHO) and the Tropical Health and Education Trust (THET) to extend our educational work to sub-Saharan Africa, with the help of our international MSc students. Enjoy the read & the holidays!

Improving Resuscitation in Trauma clinical care. Ultimately patients with TIC have increased blood transfusion requirements and suffer more adverse outcomes (e.g. multi organ failure).

Background In the New Year C4TS begins the targeted recruitment of 400 trauma patients across a European network of specialist centres, to a 2year randomised controlled trial entitled “Implementing Treatment Algorithms for the Correction of Trauma Induced Coagulopathy (iTACTIC)”.

Half of all trauma deaths result from uncontrolled bleeding, with 1 in 4 of all severely injured and shocked patients developing a clotting abnormality (i.e. trauma induced coagulopathy; TIC) within minutes of injury. Many more injured patients will go on to develop different types of coagulopathy at different times during the course of their treatment, either as a result of their body’s ongoing response to trauma or as a consequence of their Centre for Trauma Sciences

Current management of these bleeding and coagulopathic patients comprises protocol-led transfusion of red blood cells, plasma and clotting product supplements. In the absence of rapid diagnostic tests, these blood products are administered to patients, ‘blind’ to the type and severity of TIC they may have, or indeed even if they do not have TIC. Conventional laboratory tests of coagulation are not presented in a clinically useful time frame, on average becoming available to the treating trauma team only after 90 minutes. So called ‘Viscoelastic Haemostatic Assay (VHA)’ systems can now provide point-of-care test results within 10 minutes.

www.c4ts.qmul.ac.uk

Professor Susan Brundage (Education Lead)

by Dr Simon Eaglestone (Head of Operations) VHA can be used to identify TIC early and to guide transfusion of blood products more effectively, by matching to that individual patient’s ongoing needs. The trial will compare the outcomes of patients treated using the conventional blood transfusion strategy versus those treated using a personalised VHA-led algorithm. Regardless of randomisation, all patients will initially receive the same local treatment, according to the best currently available evidence.

Timeline iTACTIC will recruit around 400 patients from trauma receiving hospitals in London (Royal London Hospital), Oxford, Oslo, Cologne, Amsterdam and Copenhagen. The trial will conclude at the end of 2017 and we’ll be sure to update you on the results in the Spring 2018 Newsletter!

The Trial

ClinicalTrials.gov: NCT02593877

iTACTIC is designed to find out if

More information here.

Newsletter Autumn 2015

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Education and Outreach

Pushing the education frontiers C4TS is the only institution in the world to offer distance learning post-graduate courses in trauma sciences.

The Centre offers MScs in Trauma Sciences, Trauma Sciences (Military and Humanitarian) and Orthopaedic Trauma Sciences. According to Course Director Professor Susan Brundage “It’s been a wonderful experience creating these pioneering courses and seeing just how much they deeply engage students.”

“Trauma is a young branch of medical science, only formally recognised as a discipline over the last 20 years.

We have achieved so much (a 50% drop in mortality over the five years in London alone), but WHO advise that up to 40% of global injury deaths could be averted by strengthening trauma care systems in low to middle income countries.”

“That is why we have now embarked on projects with WHO and the College of Surgeons, East, Central and Southern Africa (COSECSA) that will extend our educational reach to developing countries.”

Piloting distance learning in Malawi The Centre is partnering with the College of Surgeons, East, Central and Southern Africa (COSECSA) to assess if C4TS distance learning programs could provide a costeffective model for training local trauma clinicians in Malawi.

With COSECSA’s support, Professor Brundage has received a Tropical Health Education Trust (THET) grant to partner with the University of Malawi College of Medicine to undertake the project ‘Evaluation of Distance Centre for Trauma Sciences

Newsletter Autumn 2015

Dr Terri Reynolds, WHO Emergency and Trauma Care program scientific lead, lecturing at the C4TS summer school 2015

Learning Trauma Sciences curriculum on Trauma and Orthopaedic Training and Health Outcomes in Malawi’.

The objective is to learn what content from the trauma MScs might need to be adapted to the needs of the SubSaharan African environment, and assess if distance learning is logistically feasible for trainee clinicians.

If successful, the courses could be rolled out beyond Malawi to other African counties and other low to middle income countries (LMIC).

A Trauma System Assessment Tool C4TS are also working with WHO to devise standardized tools and techniques for assessing the need for prehospital and facility-based capacity in trauma and emergency care, and reviewing emergency care policy and legislation.

Dr Terri Reynolds, scientific lead for WHO Emergency and Trauma Care programs, is overseeing the development of a Trauma System Assessment Tool (TSAT), with input from Professor Brundage in design and piloting.

The TSAT is a survey that engages respondents from a range of different trauma system settings, including: policy makers; hospital administrators; heads of surgery, trauma, medicine, critical care, or emergency units; trauma care providers; rehabilitation specialists; pre-hospital care leaders; and injury researchers or epidemiologists. TSAT results will help care planning agencies assess trauma systems maturity, identify capability deficits, and guide priorities for trauma systems development.

C4TS MSc trauma sciences students will have the opportunity to collect data for TSAT in their individual country, as part of their dissertation project.

More information about C4TS MSc courses can be found here Follow us on Twitter @TraumaMasters and @OrthoMasters 2

New staff and research projects

News and Events

Contact pathway clotting analysis

London Trauma System dramatically reduces mortality

Bleeding due to trauma-induced coagulopathy (TIC) is one of the most significant causes of mortality in trauma patients. A component of TIC is fibrinolysis (clot breakdown) which is over-activated in 57% of trauma patients.

Tiziana Marchesi

The contact pathway is a group of plasma proteins that responds in presence of pathophysiological materials and pathogens activating both the coagulation and the inflammation system. It can activate fibrinolysis by cleavage of plasminogen to plasmin but, on the other hand, can also inhibit fibrinolysis through activation of an intrinsic pathway which also affects clot strength.

In trauma patients there is a high release of many elements that could activate or inhibit the contact pathway or the intrinsic pathway. To date there have been no studies specifically into the role of the contact pathway in traumatic haemorrhage and its effect on fibrinolytic activation. The aim of my project is to discover how the contact pathway is involved in fibrinolysis activation and if it could be used to modulate this clotting disorder during trauma haemorrhage to improve patient outcomes.

Tiziana talks more about her experience as a C4TS research fellow in this video.

Trauma Data Collection

Helen Sumbo Olaniyi

I have just joined the trauma research team as the European Database Research Assistant. My main role is to collect trauma patient information and submit that to UK and international trauma registries. The data supports ‘research that provides accurate and relevant information to help Doctors, Nurses and Managers improve their services.'

Some of the data I collect includes patient's personal details, pre-hospital incident details, A & E details, injury details, operative procedures and outcomes such as discharge home or transferred to another hospital. I love my job because I know the data collected aids trauma audits and research to improve management of patients.

Platelets and coagulopathy

Paul Vulliamy

I've recently joined the C4TS as a research fellow, having taken time out of my training in general surgery.

My project will involve studying the interplay between coagulation and inflammation in trauma patients, with a particular focus on the role of platelets in the development of acute traumatic coagulopathy and organ dysfunction.

I am also studying the efficacy of platelet transfusions in bleeding trauma patient care.

Centre for Trauma Sciences

Newsletter Autumn 2015

The C4TS led 'Evaluation of the London Trauma System (ELoTS)' study has been published in the Annals of Surgery.

The study evaluated care after the implementation of the London Regional Trauma System in 2010 and found that the quality of care had dramatically improved, resulting in a 50% increase in survival rates since 2007.

The study was led by Dr Ross Davenport, Clinical Academic Lecturer and Dr Elaine Cole, Senior Research Fellow at C4TS. We highlighted this study in Issue 3, and you can read the full article here The dangers of rugby In September and October, the UK hosted the Rugby World Cup and C4TS Public Policy lead Professor Allyson Pollock was in the news highlighting the sport's risk of brain injury, particularly for children. Professor Pollock was interviewed on the BBC World Service, the Today program, Soho Radio and you can read her opinion piece in The Guardian.

You can find more information about C4TS Public Health and Policy projects here.

You can contact us via our website or tweet @CommsC4TS

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