Identifying the best treatment for open fractures
Negative Pressure Wound Therapy (NPWT) is an alternative dressing for open fractures, which are at much greater risk of infection due to the broken bone being exposed to contamination from the outside environment. NPWT creates a partial vacuum using suction, and whilst popular with surgeons, there was little information about its effectiveness.
The WOLLF (Wound Management of Open Lower Limb Fractures) trial aimed to compare NPWT with standard dressings for open fractures of the lower limb.
The NIHR Clinical Research Network (CRN) Trauma and Emergency Care specialty used their expertise to work with the study team to identify additional sites and consent patients to take part in the trial.
The study was funded by the NIHR Health Technology Assessment (HTA) Programme and supported by the NIHR Oxford Biomedical Research Centre (BRC) and the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford.
- Our impact case study outlines how the results are set to change clinical practice and why the trial marks a step change in how major trauma research is delivered in the UK.
Tranexamic acid (TXA) in trauma
The NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC) has taken the lead in supporting the use of tranexamic acid (TXA) by paramedics and others involved in emergency care for trauma patients, saving approximately 400 lives a year in the UK (CRASH-2 trial data).
Previous research had shown that, if used within three hours after trauma, TXA reduces the risk of death from bleeding by as much as 30%. Despite the costs being low and there being virtually no side effects, there had been little implementation within the NHS. After an initial review of the evidence, it was decided that an effective way of delivery would involve the drug being administered by paramedics as well as in A&E, using a protocol that has been agreed upon with emergency departments.
CLAHRC South West Peninsula worked with the South West Ambulance Service NHS Foundation Trust (SWAST) and the acute trusts to support all emergency services in the south west in carrying TXA. As a result of this successful implementation, the use of TXA was incorporated into the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) National Guidelines for use across the UK. All emergency ambulance services across England now carry TXA, saving lives in the most extreme cases of injury.
Diagnostic tests for heart attack
Chest pain is the most common reason why patients are admitted to hospital in an emergency. However, most admissions could be avoided with better diagnostic tests for acute myocardial infarction; commonly known as a heart attack.
The aim of the TRAPID-AMI study, which was supported by the NIHR Clinical Research Network (CRN) Trauma and Emergency Care specialty, was to demonstrate whether use of a high sensitivity test for troponin T would enable an accurate and more rapid diagnosis of a heart attack, in order to safely rule out heart attacks in the Emergency Department at an earlier stage.
Improving survival from emergency bowel surgery
Doctors in Southampton are leading a national trial of a treatment approach that could improve survival from emergency bowel surgery by guiding the amount of fluid given to patients during their operations.
The protocol uses a heart monitoring device that tracks the amount of blood being pumped by the heart during and after surgery so that exact amounts of fluid can be given when required to improve blood flow.
The study is funded by the NIHR Health Technology Assessment (HTA) Programme and led by the NIHR Southampton Biomedical Research Centre.
Find an Trauma and Emergency Care study in your area
You can find out more about Trauma and Emergency Care studies in your area through the Be Part of Research website.
The NIHR provides researchers with the practical support they need to make clinical studies happen in the NHS and social care. 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. This support covers every stage of research, from set up to delivery.
We provide world-class health service infrastructure - research support staff such as clinical research nurses, and research support services such as pharmacy, pathology and radiology - to support organisations seeking to conduct clinical research in the NHS in England. Some of this research is funded by the NIHR, but most of it is funded by NHS non-commercial partners and industry.
We support the set up and delivery of clinical research in the NHS through our Study Support Service and our Research Design Service helps researchers develop proposals to secure funding from our research programmes.
We support and oversee a wide range of research studies. Examples range from “major trauma” in road accidents or falls, burns, anaphylaxis (serious allergic reaction), asthma attack, and cardiac arrest, through to carbon monoxide poisoning, broken bones and sports injuries. In addition, this specialty area also includes some aspects of recovery and rehabilitation after injury, which takes place in a non-emergency setting.
We support and promote research in the following areas:
- Pre-hospital Care
- Emergency and acute care
- Sports injuries
- Rehabilitation after injury
- Trauma orthopaedics
- Poisoning and self harm
Injuries and emergencies is a diverse and rapidly growing specialty. To ensure that we can provide the right advice and support to the full range of studies, we have created two specialist communities within our specialty. These are:
- pre-hospital and emergency department care
- musculoskeletal injury
Understandably, there are considerable overlaps with other specialty areas and in many cases our members and associates will work closely with colleagues from other specialty areas within the NIHR.
National Trauma and Emergency Care Specialty Group
Each of our 15 Local Clinical Research Networks has at least one nominated local Clinical Specialty Research Lead for Injuries and emergencies. These clinicians lead research groups to promote and support Trauma and Emergency Care research within the NHS Trusts in their area.
At a national level the local leads come together to manage the national Trauma and Emergency Care clinical research portfolio. This involves regularly reviewing the progress of studies, identifying barriers to recruitment, and coming up with solutions and strategies to help overcome those barriers. Our National Specialty Group of clinical experts offer advice and support to commercial and non-commercial customers looking to conduct research in the NHS.
Trauma and Emergency Care Specialty Profile
The Trauma and Emergency Care Specialty profile gives an overview of our offer to the Life Sciences Industry.
We are working with key stakeholders to promote the successful delivery of research studies in the NHS and to help plan new studies that will address patient’s needs.
We collaborate with other national networks, including Trauma Networks. Major trauma incidents are relatively rare and most hospital accident and emergency departments see fewer than one case per week. Because major trauma is so uncommon, it is not possible for all hospitals to have the specialist equipment and doctors needed. With this in mind, regional Trauma Networks were set up across England from April 2012 to cope with major trauma services.
The establishment of the Trauma Networks has created a major opportunity to deliver high quality trauma research in a specialist setting. To make the most of this opportunity, NIHR-supported research must be integrated within the Trauma Networks. Work is ongoing to promote and maintain collaboration between the NIHR and Trauma Networks.
The National Ambulance Research Steering Group
The NIHR Clinical Research Network Trauma and Emergency Care National Specialty Group membership includes representation from the National Ambulance Research Steering Group (NARSG).
The British Burns Association
The British Burns Association (BBA) is a non-profit making organisation which aims to take forward activities associated with burn prevention, and the propagation of knowledge on the best treatment and rehabilitation following a burn injury. The NIHR Clinical Research Network Injuries and Emergencies National Specialty Group membership includes representation from BBA.
The NIHR provides the support and facilities the NHS needs for first-class research by funding a range of infrastructure.
NIHR Biomedical Research Centres
NIHR Biomedical Research Centres (BRCs), partnerships between England’s leading NHS organisations and universities, conduct translational research to transform scientific breakthroughs into life-saving treatments. The following BRC undertakes research in injuries and emergencies:
NIHR Medtech and In vitro diagnostics Co-operatives
NIHR Medtech and In vitro diagnostics Co-operatives (MICs) build expertise and capacity in the NHS to develop new medical technologies and provide evidence on commercially-supplied in vitro diagnostic tests. The following MIC undertakes research in injuries and emergencies:
NIHR Health Protection Research Units
NIHR Health Protection Research Units (HPRUs) are research partnerships between universities and Public Health England and act as centres of excellence in multidisciplinary health protection research in England. The following HPRU undertakes research in brain injuries and emergencies:
NIHR Surgical Reconstruction and Microbiology Research Centre
The NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC) is a national centre for trauma research, taking discoveries from the military frontline to improve outcomes for all patients. Multiple studies are run from this centre all year round by scientists and academics from the Ministry of Defence, the Department of Health and Social Care, University of Birmingham and the Queen Elizabeth Hospital.
Work with our infrastructure
All of the NIHR facilities and centres are opening to working with the public, charities, industry and other partners. If you are interested in collaborating with the NIHR please contact the NIHR Office for Clinical Research infrastructure: email@example.com
Our experts in the NIHR Clinical Research Network National Specialty Group can advise on delivering your injuries and emergencies study across health and care settings.
National Specialty Lead
Professor Matthew Costa
Professor Matthew Costa is the NIHR Clinical Research Network National Specialty Lead for Trauma and Emergency Care.
Professor Costa PhD, FRCS (Tr&Orth) is Professor of Orthopaedic Trauma Surgery at the University of Oxford and Honorary Consultant Trauma Surgeon at the John Radcliffe Hospital, Oxford.
Professor Costa’s research interest is in clinical and cost effectiveness of musculoskeletal trauma interventions. He is Chief Investigator for a series of randomised trials and associated studies supported by grants from the UK NIHR, Musculoskeletal Charities and the Trauma Device Industry.
His work has been cited widely, and informs many guidelines from the National Institute for Health and Care Excellence. Professor Costa is Chair of the NIHR Clinical Research Network Trauma and Emergency Care Specialty Group.