Barts C4TS Spring 2019 Newsletter

www.c4ts.qmul.ac.uk

C4TS Newsletter Spring 2019 Issue 18

C4TS RESEARCH NEWS SPRING 2019 Welcome to the Centre for Trauma Sciences (C4TS) Spring 2019 newsletter. In this edition, we’re delighted to announce the launch of the AfterTrauma recovery app after two years in development. We also describe two new C4TS studies: EmPHATTIC, which applies machine learning to the early treatment of severely bleeding trauma patients, and TELA, the first national audit into emergency trauma patient laparotomies. Our new educational programme TSCIPP has attracted a lot of interest, and we provide an overview of what this innovative four year course offers students. Finally, Prof Brohi outlines the London Major Trauma System’s public health policy on knife violence reduction.

AfterTrauma Recovery App launch

by Nicole Skeltys, Communications Officer

New self-management app provides help to trauma survivors and carers.

After more than two years in development, the AfterTrauma Recovery app (Version 1) is now available for download from the Apple store and the Google Play store. Funded by a generous grant from Barts Charity, the purpose of the app is to help survivors of serious injury – and their carers – rebuild their lives.

The app was co-designed with a dedicated group of trauma survivors, carers and clinicians. Different features were tested with both trauma inpatients and outpatients at the Royal London Hospital as the app was being developed.

The app is the vision of Dr Karen Hoffman, who identified the need for such a resource after many years working with trauma patients in her capacity as a trauma rehabilitation specialist. Dr Hoffman says: “I’m delighted that we have a version of the app that anyone can now download and try for themselves. The app is designed on self-management principles, which help patients to find the motivation and take responsibility for improving their wellbeing.”

“The feedback from patients and clinicians from around the world so far has been overwhelmingly positive. We feel it is still early days though, and we are gathering more detailed feedback from patients and clinicians to improve the next version of the app.”

You can download the app and also provide feedback by going to: www.aftertrauma.org/recoveryapp

App Features A recovery tracker. Shaped like a flower to represent different aspects of life, each petal helps the user track and see their progress. When a simple My Recovery questionnaire is repeated over time, the petals grow or shrink to show you where you are on your journey.

Diary. The diary section allows the user to take notes and load pictures about recovery. You can export pages to share with family, friends and clinicians via email and social media.

Challenge builder. The user can set challenges and activities to help with recovery.

There are some suggestions built into the app, but you can also set your own. Notifications remind you to continue with your challenges, and goals achieved appear in your diary.

Rehab plan. Take a picture of your rehabilitation plan so you always have it in one place and can share it with family, friends and clinicians as you wish.

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C4TS Newsletter Spring 2019

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Cryostat2 Trial Update

by Mr Ross Davenport, Co-Investigator Chat is where users can connect with others recovering from injury, and share tips and support to help each other.

Trauma voices.

Throughout the app, trauma survivors and carers share their experiences and tips for recovery through text and videos. There is also a dedicated section for trauma survivor stories.

Information. There is a lot of useful information to help you recover, ranging from rehab exercises, advice on returning to work, dealing with post-trauma stress, relationship impacts and more.

CRYOSTAT2 is a Randomised Control Trial designed to determine if the addition of cryoprecipitate to the current Major Haemorrhage Protocol improves trauma patient survival. Overall UK recruitment for the trial is currently 472 patients, with 23 sites open and recruitment rates consistently above target. In May 2019 we will be holding our second national investigators meeting to discuss trial updates, recruitment progress and celebrate the success so far.

In February 2019, I published an editorial in the British Journal of Anaesthesia discussing the rationale for CRYOSTAT2 and noting how rapidly the UK trauma system has matured, as evidenced by the enthusiasm and engagement of all Major Trauma Centres to deliver a

clinical trial of bleeding trauma patients across the country, recruiting 24/7.

Two new sites in Northern Ireland and Wales are likely to come online mid2019, and the US Food and Drug Administration is currently reviewing a proposal for five US sites to join the trial sometime this year.

Further details of the study are available on the clinical trial site.

Trauma Emergency Laparotomy Audit The Trauma Emergency Laparotomy Audit (TELA) is the first study from the National Trauma Research and Innovation Collaborative (NaTRIC).

NaTRIC was established by C4TS in June 2018 with the aim of delivering high quality audit and research projects at a national level that will improve care of the seriously injured.

TELA, which commenced on 1st January 2019, is a national, six month observational study of patients that require an abdominal operation after sustaining a traumatic injury. Over 40 hospitals are involved across the UK, including all Major Trauma Centres in England. C4TS are collating TELA aims to address this gap in data results. collection. By collecting relevant data on all trauma patients who undergo Patients with serious abdominopelvic injuries frequently undergo laparotomy within 24 hours of admission laparotomy as a part of damage control resuscitation. Improved prehospital C4TS hopes to provide a clear account care, earlier damage control resuscitation, and improved transfusion of damage control resuscitation and practices have been widely perceived as advances in the care that these laparotomy in the UK. The findings of patients receive. Despite this, the literature from major trauma centres, this audit will identify areas for further both in the UK and the US, show that mortality in these patients has not research and innovation, and will improved over the past 20 years. The reasons for this are unclear due to ultimately improve patient outcomes. heterogenous and incomplete data capture, and the fact that the National Emergency Laparotomy Audit (NELA), conducted by the Royal College of More information on TELA and other Anaesthetists, currently excludes trauma patients.

NATRIC studies here.

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Can Machine Learning Improve Trauma Patients’ Outcomes?

by Major Max Marsden, Clinical Research Fellow Background The Emergency Pre-Hospital Artificial Intelligence in Transfusion and Trauma Induced Coagulopathy (EmPHATTIC) study is a novel implementation study that has just been started by researchers within C4TS. The study explores the effect of introducing a machine learning tool to help clinicians make decisions for injured patients.

The tool has been designed to help emergency clinicians identify high risk patients before they arrive in hospital.

The tool is designed to give a clinician personalised information about a patient within the first few minutes of treatment. The tool was trained and validated on 1000 patients from the ACIT study. It quantifies a patient’s risk of developing trauma induced coagulopathy (TIC) and needing a blood transfusion. TIC is a clotting dysfunction that affects about 1 in 4 seriously injured patients, and exacerbates bleeding, transfusion requirements, morbidity and mortality.

The tool currently has a web-based interface. Clinicians can enter information about a patient and then the tool uses a machine learning model to produce an output of risk. The specific type of machine learning algorithm we use is a Bayesian Network. The tool was designed

by C4TS researcher Zane Perkins with assistance from computer scientists at QMUL. Study objectives The objective of EmPHATTIC is to assess the tool’s potential to improve patients’ care. We have shown retrospectively that the tool is accurate. What we need to understand now is whether the tool can retain that accuracy when used very early after injury, and whether it enhances decision making above the decision standard that the clinicians already make.

Method Clinicians involved in the study will not be shown the tool’s prediction, so that differences between clinician predictions and those generated by the tool, including the amount of blood transfusion needed, can be measured.

These differences will be recorded after the clinicians have performed the first assessment of the patient (primary survey) and before hospital arrival.

The study will enrol clinicians across two air ambulance sites; London’s Air Ambulance and Kent, Surrey and Sussex Air Ambulance. Patients will not be required to undergo any additional procedures. The study started in January 2019 and will run until August 2019.

Screenshot of the web interface clinicians will use to help predict a patient’s risk of trauma induced coagulopathy (also known as acute traumatic coagulopathy) Next steps If EmPHATTIC results suggest machine learning has the potential to improve patient outcomes, C4TS plans to conduct follow on studies. The subsequent study will require approval from the Medicines and Healthcare Products Regulatory Agency to give the tool’s result to clinicians during patient care in a randomised control trial.

For more information, contact Max Marsden

Are you interested in getting involved with C4TS research? Then why not join the Patient/Public Advisors for Injury Research (PAIR) Group. You can help shape research priorities, communicate information to patients and much more. Contact Nicole to find out more about this exciting group.

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KNIFE CRIME: A PUBLIC HEALTH APPROACH Professor Karim Brohi outlines the London Major Trauma System’s policy on knife violence reduction.

Knife crime is sadly endemic in London, and is concentrating in areas of socioeconomic deprivation. Our study of stab injury patterns in London’s youth, which was published in the November 2018 edition of the BMJ, and summarised in the last C4TS newsletter, showed the need for a public health response to this disturbing trend.

Criminal acts are an issue of law and order, but the reasons why children and young people carry knives and resort to violence are a societal and public health issue.

A public health approach to preventing knife violence is a multi-level framework that addresses the root causes of violence, as well as those already involved or at risk.

Myself and colleagues from across the London Major Trauma System have produced a document which outlines our model of a public health approach to knife violence prevention. The aim of the document is to promote understanding of what is meant by a public health approach. The overarching principle is to: IMMUNISE the general population, PROTECT those exposed and RESCUE those at risk.

The approach is summarised in the diagram below, and the full document can be accessed here.

C4TS lead Professor Karim Brohi London News

Major

Trauma

System

by Dr Elaine Cole, Director of Research & Innovation The Multiple Organ Dysfunction in Elderly Trauma (MODET) study recruitment phase has finished (a month early) and we are currently cleaning and locking the data!

It is a massive achievement to have enrolled 1366 patients over four sites (the four Major Trauma Centres). I would like acknowledge the two QMUL research nurses Bebhinn Dillane and Robert Christie, and the trauma research teams and Principal Investigators at St Marys, the Royal London, Kings College and St Georges hospitals for all of their hard work.

Data analysis starts now!

Find out more about what’s happening across the London Major Trauma System on our website: www.londontraumasystem.org

A Public Health Model of Knife Violence Prevention

Barts Charity’s Transform Trauma appeal seeks to raise community awareness of the impact of traumatic injury and the need for further investment in trauma research and treatments. You can help by sharing the Charity’s videos on social media, starting your own fundraising activity or simpy donate by visiting the appeal page: https://www.justgiving.com/campaigns/charity/blc/transformtrauma

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EDUCATION NEWS Our new Trauma Sciences Care of the Injured Patient Programme provides medical students with a unique opportunity.

by Mathew Jean Sam Robathan, TSCIPP co-ordinator The Trauma Sciences Care of the Injured Patient Programme (TSCIPP) is a new four year Student Selected Component (SSC) developed by C4TS that offers a unique opportunity for medical students to gain both clinical and research experience from some of the best trauma staff in the country.

As a four year programme in the Barts and The London School of Medicine and Dentistry, students who join get to stay on the programme until the end of their time at medical school, allowing them to fully develop their interest and skills in trauma medicine. The programme has been devised entirely by medical students such as myself, under the guidance of C4TS leads.

Medical students listen to Mr Ross Davenport discuss haemorrhage management at the first Trauma Late in November 2018

Themes for each year are: Trauma Care Systems; Intro to Public Health; Research; and Education, Leadership and Peer Mentorship. Details about what students can expect to learn on these topics can be found here.

On 4th March 2019, our first call for TSCIPP applications closed. I’m delighted to report that we received 73 applications for the programme! I think this is an indication of the rising interest amongst medical students in trauma as a specialist field of knowledge, and also a testimony to the quality of the SSC.

Education

Award

The TSCIPP programme is supported by monthly events called Trauma Lates, where speakers from academic, research and other backgrounds tackle specific challenges in trauma care. Trauma Lates are open to everyone with an interest in the treatment of serious injuries, more info here.

for

C4TS

MScs

On 20 February 2019, Professor Susan Brundage was one of the recipients of the inaugural Queen Mary University of London (QMUL) Awards for Education Excellence. The awards recognise faculty who have excelled at providing high quality educational experiences for students, including encouraging student engagement through co-creation, supporting excellent student learning outcomes, and providing an excellent student environment.

Professor Brundage was recognised for her work in developing and expanding the pioneering distance learning MScs in Trauma Sciences, Trauma Sciences (Military and Humanitarian) and Orthopaedic Trauma Sciences.

Professor Brundage commented: “I’m delighted to receive this award. When I joined the trauma MSc programmes in 2013, it was always my hope that we would equip students with the advanced skills and knowledge to go on to make real impacts in trauma patient care. The programmes now attract students from all around the world, and are accredited by the Royal College of Surgeons of England, the only UK post-graduate trauma course to have achieved this distinction.”

“It was a huge team effort that has helped make the QMUL Trauma Sciences Suite of MSc Programmes such a success – specifically C4TS visionary lead Professor Karim Brohi, key faculty staff Mr Kash Akhtar, Dr Elaine Cole, Mr Ross Davenport and Mr Peter Bates, Krys Gunton for superb admin support, C4TS Operations Manager Dr Tom Simpson for strategic & logistical guidance, the invaluable contributions of our treasured international honorary faculty and of course the enthusiasm of current and past students.“