Injury Research at EMAG

Coagulation Following Severe Injury

In 2003 Prof Coats published the first definition of  a new clinical syndrome, later named ACOT - Acute Coagulopathy of Trauma (also know as Trauma induced Coagulopathy - TIC). He then investigated possible causes of ACOT and had the idea for an intervention to treat the disease using an antifibrinolytic. This was synthesised in a Cochrane review which determined the need for a large randomized controlled trial. Prof Coats was clinical lead for the CRASH2 trial , a member of the Trial Management Group, the Trial Steering Group and the Writing Committee (Chief Investigator Prof Ian Roberts). The trial results were published in the Lancet in 2010 with a subsequent subgroup analysis being published as a separate paper in the Lancet in 2011. An analysis of the effect across the spectrum of injury severity was published in the BMJ in 2012.

Changes in practice directly resulting from this work:
1) UK military Standard Operating Procedures were changed in 2010 so that every UK combat casualty now receives tranexamic acid.
2) The WHO ‘Essential Medicines’ committee has included tranexamic acid on the list of essential medicines (2011).
3) Evidence to WHO includes an estimate of potential 100 000 lives a year saved by this intervention.
4) US military has included tranexamic acid in its Tactical Combat Casualty Care protocols.
5) The European Guideline (Prof Coats a co-author) on treatment of bleeding following injury changed in 2013 to include tranexamic acid.
6) Most UK hospitals have changed their massive transfusion protocols to include the use of tranexamic acid.
7) Worldwide interest in coagulation following trauma as a new research area (A Pubmed search on “Acute Coagulopathy of Trauma” or “ACOT” gives 600 hits). This is likely to become very much larger as the field is only just starting.
8) Three new mega-trials have led directly from this work – the 10 000 patient WOMAN trial of antifibrinolytic in post partum haemorrhage (the leading cause of maternal death in the developing world), the HALT-IT study - an 8000 patient trial of the effect of tranexamic acid in patients with gastrointestinal haemorrhage, and the CRASH3 study - an evaluation of the effect of tranexamic acid in head injury.

From the University of Leicester Emergency Medicine Academic Group we have developed advice to UK Emergency Physicians on the best way to implement tranexamic usage in emergency care and an educational podcast.

Trauma Epidemiology

The Leicester EMAG has an interest in the epidemiology of severe injury and the use of population databases to examine both clinical management and injury prevention.

TARN

Prof Tim Coats Chairs the Trauma Audit and Research Network (TARN). This is the leading UK organisation for clinical audit and clinical research in trauma care. Currently (2012) 98% of UK Acute Hospital Trusts belong to this network. TARN publications can be found here.

European Trauma Research Network

Leicester EMAG is linked to injury researchers around Europe, with a close association with the European Trauma Audit and Research Network(EuroTARN). Prof Coats chaired the "Utstein Major Trauma Group" which published the standard European definitions for injury registries. Our survey of European Trauma Registries can be found here.

CTARP

Dr Rod Mackenzie (formerly Senior Lecturer with EMAG) leads the Cambridgeshire Trauma Audit and Research Project. Dr James French (EMAG MD Student) is completing a thesis on this dataset. The CTARP project is supported by MAGPAS, a prehospital care charity. Details of MAGPAS research can be found here.

A presentation about CTARP can be found here.

BRAKE

Providing a direct route from trauma prevention research to public education Prof Tim Coats is Trustee of BRAKE, a road safety charity.

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