Trauma Sciences
Lead: Professor Karim Brohi
Since 2008 the unit has grown strategically, developing bench and translational research programmes with partners in QMUL and the Royal London Hospital that span the complete breadth of Trauma disciplines. In addition the unit also leads national, European and international networks comprising civilian and military partners committed to maximising the impact of research and education in Trauma Sciences.
The unit promotes the effective sharing of knowledge between academia, public Trauma care systems and defence medical services. We are also leading recruiters for international multicentre clinical studies and the international lead for a novel oxygen therapeutic trial. In 2011 the unit was recognised as the United Kingdom's lead centre of excellence for research into Complex Trauma Care, by an independent RAND report commissioned by the Department of Health.
Trauma is the world’s 4th leading cause of death and the number one cause of lost life years. The burden of disease is highest in children and young adults, with 90,000 deaths each year in the European Union in people under 30 years old.
Only second to traumatic brain injury, some 40% of all trauma deaths are the result of blood loss. 1 in 4 trauma patients develops abnormal clotting within minutes of injury, exacerbating ongoing blood loss. Our units research is supported by the NIHR, industry, military and charitable organisations and comprises three principle research streams with a focus on; 1) understanding the body’s response to traumatic injury, 2) improving the diagnosis and treatment of trauma-associated clotting & inflammatory abnormalities and 3) the assessment of complex & long-term outcomes in trauma patients.
Much of our trauma research begins in the Emergency Department, immediately upon admission of the patient. Through the collection of trauma patient data (e.g. demographics, injury patterns, physiology) and the analysis of their blood (e.g. functional clotting, platelet & factor levels), we aim to reveal the mechanisms and consequences by which trauma-induced disturbances of the body's coagulation and inflammation system occur. By also measuring changes that occur during the patients clinical course (e.g. transfusion of blood components, procoagulant therapeutics), a robust evidence base can be provided to further our understanding of the how best to manage trauma-associated haemorrhage, thereby improving outcomes and saving blood.
The recruitment of nearly 1000 study patients and analysis of their blood has significantly changed our understanding of trauma-induced coagulopathy (i.e. not consumption, loss or dilution of clotting factors) and identified new syndromes:
- “Occult hyperfibrinolysis” – a large previously undiagnosed proportion of trauma patients that have increased breakdown of clots that impairs control of blood loss whether by transfusion or surgery.
- “Trauma-Induced Secondary Cardiac Injury” - trauma causes severe cardiac dysfunction (e.g. arrhythmias, heart attacks & death), even in the absence of direct injury to the heart.
The unit is leading a 5-year nationwide study involving 22 UK trauma centres to reveal the national incidence of trauma, what we currently do in the UK regarding transfusions for trauma haemorrhage, and ultimately what is ‘best practice’ for optimal patient outcomes. We are developing computer models that will enable us understand & test the impact of trauma, blood transfusion and procoagulant drugs, as well as helping both clinicians & patients/soldiers to make informed decisions about their course of clinical care/surgery following traumatic limb injury. We are also developing and validating effective tools for the assessment of trauma patients rehabilitation needs, the impact of trauma upon their long-term capabilities and their quality of life. These are all absolutely critical tools for the effective measurement of our research, clinical trials and the monitoring and enhancement of clinical care practice.
Research Projects
“Activation of Coagulation and Inflammation in Trauma”.
“Traumatic Coagulopathy & Massive Transfusion – Improving outcomes and saving blood”.
“Trauma Outcomes Core Facility”.
“Point of care diagnostics for the rapid identification of Acute Traumatic Coagulopathy and prediction of massive trauma haemorrhage”.
“Occult Hyperfibrinolysis in trauma – a hidden killer”.
“Platelet function in Trauma-Induced Coagulopathy - The effects of administered platelet concentrates on coagulation and clinical outcomes”.
“Characterising cytokine response to tissue damage after traumatic injury.
“Traumatic tissue damage - the search for Trauma DAMPs”.