Trauma and Emergency Care and the James Lind Alliance
The James Lind Alliance (JLA) is a non-profit organisation hosted by the NIHR which aims to raise awareness of research directly relevant and of potential benefit to patients. The guiding principle is to bring together patients, carers, and healthcare workers to identify and agree on which research uncertainties are most important.
Trauma and Emergency Care has taken a leading role in promoting Patient and Public Involvement (PPI) and in particular partnering with patients and healthcare professionals to deliver JLA Priority Setting Partnerships relevant to our specialty area. This work has led to some exciting new research projects, the results of which should improve future care for patients suffering trauma and requiring emergency care.
Three recent examples of PSPs, their research questions, and resulting studies are described below.
Research priorities in emergency medicine
JLA research priorities
Which trauma patients should be transferred to a Major Trauma Centre rather than going to another hospital first?
- NIHR HTA Commissioned Call. A national pre-hospital major trauma triage tool/process - the “Major Trauma Triage Study (MATTS)”.
In adults diagnosed with isolated sub-segmental pulmonary embolism is treatment with anti-coagulation required?
- NIHR HTA Commissioned Call: Management of isolated or incidental subsegmental pulmonary embolism - Stopping anticoagulation for isolated or incidental sub-segmental pulmonary embolism (the STOPAPE Study).
Do early undifferentiated (broad spectrum) antibiotics in suspected severe sepsis have a greater benefit and cause less harm to patients than delayed focussed antibiotics in the ED? AND In patients with sepsis does a liberal fluid resuscitation strategy versus early vasopressor use result in increased morbidity and mortality? AND In adult patients with presumed sepsis in the prehospital environment does the administration of prehospital antibiotics compared to no antibiotics decrease mortality?
- NIHR HTA Commissioned Call: Accuracy, impact and cost-effectiveness of prehospital clinical early warning scores for adults with suspected sepsis.
What is the best way to reduce the harms of emergency department crowding and exit block? We need a better measure of crowding that drives sensible improvements for the seriously ill and injured, adolescents and the frail elderly.
- RCEM funded project “Refining the National Emergency Department Overcrowding Scale (NEDOCS) as an automated real-time ED crowding tool”.
A prospective evaluation of a CT head scan rule out pathway (within 6hrs of headache onset) without recourse to lumbar puncture in ED patients with acute severe headache.
- RCEM funded TERN project “Headache in Emergency Department – the HED study”.
With regards to how ED staff development is managed, what initiatives can improve staff engagement, resilience, retention, satisfaction, individuality and responsibility.
RCEM funded TERN project “Trainee-led evaluation of the need for Inter-shift Recovery among Emergency Department doctors in the United Kingdom (TIRED) Study”.
Research priorities for the management of broken bones in the lower limb
Research priorities for the management of broken bones of the upper limb in people over 50: a UK priority setting partnership with the James Lind Alliance.
JLA Research priorities
What is the best physiotherapy and/or occupational therapy regime for adults during out-of-hospital recovery from a fragility fracture of the lower limb? AND What are the key components of a rehabilitation pathway for adults with dementia/cognitive impairment following a fragility fracture of the lower limb?
- National Institute for Health Research (RfPB) funded study - HIP HELPER - Improving patient recovery following hip fracture through caregiver support: a feasibility study.
What is the best weight bearing regime following treatment (with or without surgery) for fragility fractures of the ankle?
- National Institute for Health Research (HTA) commissioned call – The FAME (Fractured Ankle Management Evaluation) trial.
What is the best way to prevent surgical site infection in adults undergoing surgery for fragility fractures of the lower limb?
- Industry funded trial. WHiTE 8 COPAL: A Randomised Clinical Trial of low dose single antibiotic loaded cement versus high dose dual antibiotic loaded cement in patients receiving a hip hemiarthroplasty after fracture.
Research priorities for the management of broken bones in the upper limb
JLA Research priorities
Which are the most important factors which decide whether a patient over 50 with an upper limb fracture is treated with or without surgery?
- National Institute for Health Research (HTA) funded study: HUSH – the Humeral Shaft Fracture Trial. A multi-centre prospective randomised superiority trial of surgical versus non-surgical interventions for humerus shaft factures in patients aged 50 years or older.
Following the extensive work that the Trauma and Emergency Care community and the patients it serves has put into research prioritisation, the NIHR have designated their current themed call across all of their funding programmes to ‘Injuries, accidents and urgent and emergency care’. Hopefully this will lead to more trauma and emergency care studies being funded, and ultimately more of these important research questions being answered by the clinical research community.