Every year in the UK, 5000 to 8000 trauma patients die in hospital, with 40% of those deaths caused by uncontrolled bleeding. This programme aims to identify which severely injured patients will need a massive transfusion within minutes of arrival, then guide treatment precisely to stop the bleeding. The core problem is that doctors currently have no validated way to predict who will need large volumes of blood products, nor how to adjust therapy once bleeding starts. This leads to both over-transfusion—wasting scarce blood and exposing patients to risk—and under-transfusion, which can be fatal. The issue becomes critical during mass casualty events, when blood supplies are severely constrained. If successful, the research could save over 1000 lives annually among the 5000 patients affected each year. It would rationalise blood use across the NHS, reducing waste and cost while improving survival and reducing disability. The team will also model hospital transfusion services during disasters, producing best-practice guidelines for emergency preparedness. The systematic reviews and epidemiological studies will inform transfusion practice and clinical trial design internationally.
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AIMS & OBJECTIVES:This programme aims to improve outcomes for severely injured bleeding trauma patients. It is designed around the principle that early identification of patients who present with a trauma-induced coagulopathy and effective, directed therapy will lead to improved outcomes, reduced complications, rationalised transfusions and reduced costs to the NHS. Aim 1: EVIDENCE. Systematically review current evidence and develop systematic reviews on identification of coagulopathy and blood component use in traumaAim 2: EPIDEMIOLOGY. Investigate the national incidence of massive transfusion for trauma, national practice patterns and outcomes. Aim 3: IDENTIFICATION. Investigate the utility of clinical, point-of-care laboratory analyses for the identification of the need for massive transfusionAim 4: TREATMENT. Identify the optimum methods to to guide therapy and rationalise blood product administration during haemorrhage.Aim 5: DISASTER. Model the hospital use of transfusion services in mass casualty events and develop best-practice guidelines.Aim 6: ECONOMICS. Describe the health economics implications of massive transfusion and impact of changes in practice to the NHSBACKGROUND:5000-8000 trauma patients die in hospital every year, 40% from haemorrhage. Early identification and treatment may reduce mortality by up to 50%. However there are no validated methods to predict the need for transfusion nor effectively guide therapy. This leads to both over-transfusion and under-transfusion, reduction in efficacy, increased wastage and exposure to risk. This is exacerbated in disasters where timely availability of blood and component therapy is vital but severely resource constrained.RESEARCH PLANS:AIM 1: 2-year project to develop systematic reviews on traumatic coagulopathy and massive transfusion therapy.AIM 2: A 4-year project prospective multicentre study to assess the incidence of trauma massive transfusion, patterns practice and outcomes. AIM 3: A 4.5-year prospective cohort study to evaluate method to identify patients on admission who will require massive transfusion.AIM 4: A 4.5-year prospective cohort study on a subset of patients from AIM 3 to investigate methods to guide therapy.AIM 5: A 2-year project to develop a model of transfusion service provision, availability and utilization during mass casualty events. AIM 6: A health economic study parallels each aim to analyse costs and generate cost-effectiveness evidence. RESEARCH TEAM:A unique consortium of leading national trauma, transfusion and health economic centres:* Royal London Hospital Trauma Service.* National Blood Service (NBS) Clinical Studies Unit (MRC).* Systematic Review Initiative (SRI) , University of Birmingham* Health Economics Research Centre (HERC), University of Oxford.* Institute of Emergency Preparedness, Barts & the London NHS Trust. * Thrombosis & Haemostasis Unit, Queen Mary, University of London (QMUL).RESEARCH ENVIRONMENT:The Royal London is the primary trauma centre for London, has a high patient volume and an infrastructure that provides the ideal environment for clinical trauma research. The Local Comprehensive Research Network is on site. The NBS is the ideal partner to coordinate the national study into the epidemiology of transfusion. The Institute of Emergency Preparedness is an international leader in disaster assessment and management, and has key capabilities to support this study.ANTICIPATED OUTPUTS, OUTCOMES & IMPACT:With up to 5000 patients affected per year, potentially over 1000 lives could be saved annually. The associated reduction in disability and reduced costs to society and the NHS are currently incalculable, but are likely to be significant. The systematic reviews and epidemiological studies will be of international importance in both the delivery of transfusion therapy in trauma and in planning subsequent clinical trials in the field. Outputs include:* Systematic reviews of traumatic coagulopathy and massive tr
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