Injuries and Emergencies specialty profile
Why you should deliver injuries and emergencies research in the UK
The Injuries and Emergencies Specialty supports and oversees research studies that encompass an extensive range of conditions which require prompt diagnosis and treatment if the patients are to have the best outcome. This may involve pre-hospital care where urgent emergencies require immediate intervention from paramedics on site, or rapid treatment in an Emergency Department or Trauma Operating room at the hospital. Within a non-emergency setting, it can also involve some aspects of recovery and rehabilitation after injury.
Our studies range from observational trials to multicentre clinical interventions. They include studies investigating aspects of ‘major trauma’ in road accidents or falls, burns, anaphylaxis (serious allergic reaction), asthma attacks, and cardiac arrest, through to carbon monoxide poisoning, broken bones and sports injuries.
We form one of 30 communities of clinical practice that are brought together by the National Institute for Health Research (NIHR) Clinical Research Network (CRN) to provide national networks of research expertise. The Injuries and Emergencies Specialty is made up of research-interested clinicians and practitioners at both national and local levels. We work to provide injuries and emergencies studies on the NIHR CRN Portfolio with the support they need to successfully deliver to time and target.
We can provide:
The Injuries and Emergencies Speciality benefits from a UK-wide network of leading academic clinicians experienced in the efficient delivery of high-quality studies in an emergency setting.
Access to participants
Over 74,600 participants were recruited into injuries and emergencies research studies in 2018/19. We can support study teams and commercial partners with access to ‘hard to reach’ patient populations. We have mapped research infrastructure for pre-hospital care, emergency medicine and musculoskeletal trauma within England and the devolved nations, to highlight resource and aid site identification. We can also provide advice and guidance on recruitment strategies and approaches to overcoming potential barriers to successful study delivery.
Regional teams have been developed which include injuries and emergencies research staff specifically trained in the recruitment and retention of study participants within this challenging environment. These efforts ensure that injuries and emergencies studies on the NIHR CRN Portfolio are consistently delivered successfully; in 2018/19, 100 per cent of the commercial studies we supported successfully reached their target number of participants within their specified timeframes.
WOLLF (Wound Management of Open Lower Limb Fractures)
The majority of fractures to the leg are ‘closed’, i.e. the skin around the fracture is intact. However, if the fracture is ‘open’ the barrier provided by the skin is breached and the bone is exposed to contamination, which may lead to infection and disability. Open fractures require a surgical clean of the wound in the operating theatre, before a dressing is applied.
Traditionally, a sterile dressing is used and the leg is wrapped in a bandage. Negative Pressure Wound Therapy (NPWT) is an alternative dressing for this type of fracture; solid foam is laid onto the wound, which is attached to a pump which creates a partial vacuum, removing any remaining fluid or contamination from the wound.
As part of the NIHR funded WOLLF study, 460 patients across 24 major trauma hospitals took part in research comparing NPWT with standard dressings for open fractures of the lower limb. The £2.18m trial was funded by the NIHR Health Technology Assessment programme and supported by the NIHR Oxford Biomedical Research Centre.
The findings of the research showed that there was no evidence that NPWT reduced patients’ disability after 12 months, and therefore the research doesn’t support this particular treatment for severe open fractures. As a direct result of these findings, NICE clinical guidelines for the assessment and management of complex fractures will be updated and will be expected to lead to considerable cost-savings for the NHS.
The main challenges faced by the study were issues around start up at sites across the UK and the consent of patients needing ‘emergency surgery’.
The Injuries and Emergencies Specialty helped to overcome these issues by working with the study team to identify additional sites for the study, and by raising awareness of the study both locally and nationally.
The WOLLF trial was published in the Journal of the American Medical Association in June 2018.
The MCG (Magnetocardiography) Rule-out study
Creavo Medical Technologies, a UK-based company, has developed a new technology called magnetocardiography (MCG). MCG is a non-invasive technique that studies the magnetic signals from a patient’s heart, giving results within minutes. It is hoped that this technology could allow many patients to be immediately reassured that the cause of their symptoms is not a serious heart problem, allowing doctors to focus on identifying other causes and reducing the need for unnecessary hospital admission.
The CRN supported the recruitment of 756 participants at five of the UK’s largest Emergency Departments. All of the participants had MCG scans performed when they arrived in the Emergency Department, and were then followed up to establish their final diagnosis. As the MCG had to be performed when participants first arrived in the ED with a suspected heart attack, there were particular challenges around obtaining patient consent and obtaining MCG scans without interfering with routine clinical care.
The Injuries & Emergencies Specialty Group worked to identify the most feasible sites, and drew on many years of experience of its group members to build a team capable of recruiting participants in a timely way while gathering high quality data. It is hoped that the new technology may save the NHS up to £200 million per year. Results are expected in 2019.