About
291
Publications
58,360
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
24,560
Citations
Current institution
Publications
Publications (291)
Introduction
Female sex may provide a survival benefit after trauma, possibly attributable to protective effects of estrogen. This study aims to compare markers of coagulation between male and female trauma patients across different ages.
Methods
Secondary analysis of a prospective cohort study at six trauma centers. Trauma patients presenting wit...
Interpersonal violence involving knives is a major public health problem. The majority of patients are young people in urban areas, but little is known about age-specific patterns of injury and recent trends in injury characteristics. We performed a retrospective cohort study of all patients presenting to an urban major trauma centre with stab inju...
Background Haemorrhage is the most common cause of preventable death after injury. REBOA is a novel technique whereby a percutaneously inserted balloon is deployed in the aorta, providing a relatively quick means of temporarily controlling haemorrhage and augmenting cerebral and coronary perfusion, until definitive control of haemorrhage can be att...
Introduction
In the UK, 17,000 people die from injury each year, with uncontrolled bleeding the most significant cause of preventable mortality. Acute Traumatic Coagulopathy (ATC) exacerbates bleeding through the failure of blood-clotting with accelerated clot breakdown that mechanistically is driven by activated Protein C (aPC). No targeted therap...
Fibrinogen is a critical coagulation protein involved in both primary and secondary hemostasis. Cryoprecipitate preparation was first described by Dr. Judith Graham Pool in 1964 at Stanford University as a product for factor VIII replacement in patients with hemophilia A. Its use for hemophilia A has been superseded by safer, virally inactivated re...
PurposeContemporary trauma resuscitation prioritizes control of bleeding and uses major haemorrhage protocols (MHPs) to prevent and treat coagulopathy. We aimed to determine whether augmenting MHPs with Viscoelastic Haemostatic Assays (VHA) would improve outcomes compared to Conventional Coagulation Tests (CCTs).Methods
This was a multi-centre, ran...
Background:
The nature of multiple organ dysfunction syndrome (MODS) after traumatic injury is evolving as resuscitation practices advance and more patients survive their injuries to reach critical care. The aim of this study was to characterize contemporary MODS subtypes in trauma critical care at a population level.
Methods:
Adult patients adm...
Background
Rotational Thromboelastometry (ROTEM®) can detect trauma‐induced coagulopathy (TIC) and is used in transfusion algorithms. The response of ROTEM® to transfusion therapy is unknown.
Objectives
To determine the response of ROTEM profiles to therapy in bleeding trauma patients.
Patients/Methods
Prospective multicentre study in bleeding tr...
[This corrects the article DOI: 10.1371/journal.pmed.1002352.].
Flow diagrams illustrating outcomes in study cohorts.
(A) Microarray patient cohort. (B) Flow cytometry patient cohort.
(DOCX)
Objectives
To describe the epidemiology of assaults resulting in stab injuries among young people. We hypothesised that there are specific patterns and risk factors for injury in different age groups.
Design
Eleven-year retrospective cohort study.
Setting
Urban major trauma centre in the UK.
Participants
1824 patients under the age of 25 years p...
Introduction
This study presents an extensive retrospective database of patients with polytrauma following train-related injuries and highlights the key lessons learnt in this rare clinical presentation.
Materials and methods
We retrospectively collected data from 127 patients who presented to Royal London Hospital after sustaining train related t...
Trauma is a leading cause of death worldwide with 5.8 million deaths occurring yearly. Almost 40% of trauma deaths are due to bleeding and occur in the first few hours after injury. Of the remaining severely injured patients up to 25% develop a dysregulated immune response leading to multiple organ dysfunction syndrome (MODS). Despite improvements...
Objective:
Developing pragmatic data-driven algorithms for management of trauma induced coagulopathy (TIC) during trauma hemorrhage for viscoelastic hemostatic assays (VHAs).
Background:
Admission data from conventional coagulation tests (CCT), rotational thrombelastometry (ROTEM) and thrombelastography (TEG) were collected prospectively at 6 Eu...
Background:
The management of trauma patients has changed radically in the last decade and studies have shown overall improvements in survival. However, reduction in mortality for the many may obscure a lack of progress in some high-risk patients. We sought to examine the outcomes for hypotensive patients requiring laparotomy in UK military and ci...
Background:
Current management principles of haemorrhagic shock after trauma emphasize earlier transfusion therapy to prevent dilution of clotting factors and correct coagulopathy. London's air ambulance (LAA) was the first UK civilian pre-hospital service to routinely offer pre-hospital red blood cell (RBC) transfusion (phRTx). We investigated th...
Timely and adequate provision of blood following mass casualty events (MCEs) is critical to reducing mortality rates amongst casualties transported to hospital following an event. Developing planning strategies to ensure the blood transfusion demands of casualties are met is challenging. Discrete event simulation (DES) offers a novel solution to th...
Objective:
To determine the characteristics of trauma patients with low levels of fibrinolysis as detected by viscoelastic hemostatic assay (VHA) and explore the underlying mechanisms of this subtype.
Background:
Hyperfibrinolysis is a central component of acute traumatic coagulopathy but a group of patients present with low levels of VHA-detect...
Acute Kidney Injury (AKI) complicating major trauma is associated with increased mortality and morbidity. Traumatic AKI has specific risk factors and predictable time-course facilitating diagnostic modelling. In a single centre, retrospective observational study we developed risk prediction models for AKI after trauma based on data around intensive...
This review summarizes the evolution of trauma resuscitation from a one-size-fits-all approach to one tailored to patient physiology. The most dramatic change is in the management of actively bleeding patients, with a balanced blood product–based resuscitation approach (avoiding crystalloids) and surgery focused on hemorrhage control, not definitiv...
Background:
The benefits of pre-hospital emergency anaesthesia (PHEA) are controversial. Patients who are hypovolaemic prior to induction of anaesthesia are at risk of severe cardiovascular instability post-induction. This study compared mortality for hypovolaemic trauma patients (without major neurological injury) undergoing PHEA with a patient c...
Background
Fibrinogen and prothrombin have been suggested to become rate limiting in trauma associated coagulopathy. Administration of fibrinogen is now recommended, however, the importance of prothrombin to patient outcome is unknown. Methods
We have utilized two trauma patient databases (database 1 n = 358 and database 2 n = 331) to investigate t...
Introduction
Dysfunction of the coagulation system, termed trauma-induced coagulopathy (TIC), is a major problem in patients who bleed after injury. Trauma haemorrhage is considered one of the leading preventable causes of death worldwide. Deaths occur early and, despite the presence of trauma teams and large transfusions of blood products, outcome...
Background
Traumatic injury is the fourth leading cause of death globally. Half of all trauma deaths are due to bleeding and most of these will occur within 6 h of injury. Haemorrhagic shock following injury has been shown to induce a clotting dysfunction within minutes, and this early trauma-induced coagulopathy (TIC) may exacerbate bleeding and i...
Clinical evidence reveals the existence of a trauma induced secondary cardiac injury (TISCI) which is associated with poor patient outcomes. The mechanisms leading to TISCI in injured patients are uncertain. Conversely, animal models of trauma haemorrhage have repeatedly demonstrated significant cardiac dysfunction following injury, and highlighted...
In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factor...
Karim Brohi and Martin Schreiber, Guest Editors of the Special Issue on Trauma, describe a new era in exploration of the biology of injury response and translation of new opportunities into clinical practice.
Immune cell deconvolution and module analysis of Multiple Organ Dysfunction Syndrome (MODS) versus NoMODS transcriptome.
(A) Immune deconvolution heatmap shows poor differentiation between MODS and NoMODS patients. (B) Fewer markers specific to immune cell activation, but there is up-regulation of NK cell markers and down-regulation of neutrophil m...
Immune module analysis.
(XLSB)
Flow diagrams illustrating outcomes in study cohorts.
(A) Microarray patient cohort. (B) Flow cytometry patient cohort.
(DOCX)
Representative gating strategy for flow cytometry studies.
(A-C) Following exclusion of debris, lymphocytes were identified based on forward and side scatter properties, and this was followed by exclusion of doublets. (D-E) Natural killer (NK) cells were identified using CD56(+) and CD3(-) after exclusion of CD19(+) and CD14(+) cells. (F-G) T cells...
Background
Severe trauma induces a widespread response of the immune system. This “genomic storm” can lead to poor outcomes, including Multiple Organ Dysfunction Syndrome (MODS). MODS carries a high mortality and morbidity rate and adversely affects long-term health outcomes. Contemporary management of MODS is entirely supportive, and no specific t...
Trauma is responsible for a large proportion of the world's burden of disease, and is by far the biggest killer of young adults. Haemorrhage is the leading cause of preventable death and its effects are directly correlated with the incidence multi-organ failure in survivors. Trauma research is challenging due to patient heterogeneity, limited rando...
Introduction:
Platelets play a critical role in hemostasis with aberrant function implicated in trauma-induced coagulopathy. However, the impact of massive transfusion protocols on platelet function during trauma hemorrhage is unknown. The aim of this study was to characterize the effects of platelet transfusion on platelet aggregation and fibrino...
Objective:
To evaluate (1) levels of the host-defense/antimicrobial peptide LL-37 in patients with trauma and hemorrhagic shock (HS) and (2) the effects of a synthetic host-defense peptide; Pep19-4LF on multiple organ failure (MOF) associated with HS.
Background:
HS is a common cause of death in severely injured patients. There is no specific th...
Fibrinolysis activation occurs almost universally after severe trauma. Systemic hyperfibrinolysis is a key component of acute traumatic coagulopathy and associated with poor clinical outcomes, although controversy exists over optimal treatment strategies. The mechanistic drivers and dynamics of fibrinolytic activation in response to injury and trau...
Background: The combined effects of balanced transfusion ratios and use of procoagulant and anti-fibrinolytic therapies on trauma-induced exsanguination are not known. The aim of this study was to investigate the combined effect of transfusion ratios, tranexamic acid and products containing fibrinogen on the outcome of injured patients with bleedin...
Background:
The combined effects of balanced transfusion ratios and use of procoagulant and antifibrinolytic therapies on trauma-induced exsanguination are not known. The aim of this study was to investigate the combined effect of transfusion ratios, tranexamic acid and products containing fibrinogen on the outcome of injured patients with bleedin...
In North America and Australia, systems of trauma care have been shown to reduce mortality and morbidity in injured patient populations. These systems rely on a health infrastructure that can rapidly match the patient's needs to the appropriate level of care, is able to ensure expeditious transport to the right health facility, and can ensure that...
Introduction:
Lymphopenia has been associated with poor outcome following sepsis, burns and trauma. This study was designed to establish whether lymphocyte count was associated with mortality in emergency general surgery (EGS) patients, and whether persistent lymphopenia was an independent predictor of mortality.
Methods:
A retrospective review...
Background
Early survival following severe injury has been improved with refined resuscitation strategies. Multiple organ dysfunction syndrome (MODS) is common among this fragile group of patients leading to prolonged hospital stay and late mortality. MODS after trauma is widely attributed to dysregulated inflammation but the precise mechanics of t...
Background
Arterial calcification on Computerised Tomography (CT) is a marker of cardiovascular disease. It is predictive of future adverse cardiac events and mortality in many disease states. The incidence of arterial disease and its impact on outcomes of the injured is not known. The objectives of this study were to describe the incidence of arte...
Purpose of review:
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive damage control procedure for life-threatening abdominal or pelvic haemorrhage. The purpose of this review is to summarize the current understanding and experience with REBOA, outline potential future applications of this technology, and hig...
Background:
Major trauma is a leading cause of morbidity and mortality worldwide with hemorrhage accounting for 40% of deaths. Acute traumatic coagulopathy exacerbates bleeding, but controversy remains over the degree to which inhibition of procoagulant pathways (anticoagulation), fibrinogen loss, and fibrinolysis drive the pathologic process. Thr...
Background:
Multiple organ dysfunction syndrome (MODS) is associated with poor outcomes for trauma patients. Different forms of MODS may exist and have different consequences. The ability to distinguish them clinically may have implications for prognosis and treatment. We wished to study whether prolonged MODS (PRMODS) could be observed as a disti...
A772 Effects of lipid emulsions based on n-3 polyunsaturated fatty acids on metabolic and infectious complications compared with MCT/LCT lipid emulsion in critically ill patients receiving parenteral nutrition
R. del Olmo1, M.J. Esteban2, C. Vaquerizo3, R. Carreño3, V. Gálvez3, G. Kaminsky3, B. Nieto3, M. Fuentes3, M.A. De la Torre3, E. Torres3, A...
#### What you need to know
Trauma is a major contributor to the global burden of disease. Those who experience major trauma have serious and often multiple injuries associated with a strong possibility of death or disability. Nationally there are around 20 000 cases of major trauma per year in England, and over a quarter of these result in deaths....
Background:
Quality improvement (QI) programs have shown to reduce preventable mortality in trauma care. Detailed review of all trauma deaths is a time and resource consuming process and calculated probability of survival (Ps) has been proposed as audit filter. Review is limited on deaths that were 'expected to survive'. However no Ps-based algori...
Introduction:
Blunt abdominal trauma is a common reason for admission to the Emergency Department. Early detection of injuries is an important goal but is often not straightforward as physical examination alone is not a good predictor of serious injury. Computed tomography (CT) has become the primary method for assessing the stable trauma patient....
Background:
Traumatic hemorrhage is a leading preventable cause of mortality following mass casualty events (MCEs). Improving outcomes requires adequate in-hospital provision of high volume red blood cell (RBC) transfusions. This study investigated strategies for optimizing RBC provision to casualties in MCEs using simulation modeling.
Methods:...
Blood transfusion can be life-saving. Anaesthetists regularly request and administer blood components to their patients. All anaesthetists must be familiar with indications and appropriate use of blood and blood components and their alternatives, but close liaison with haematology specialists and their local blood sciences laboratory is encouraged....
Trauma hemorrhage continues to carry a high mortality worldwide. The contemporary damage control resuscitation (DCR) paradigm supports actively bleeding trauma patients until hemorrhage control is achieved. The principles of DCR center on early hemorrhage control and limiting ongoing blood loss by adopting strategies limiting fluid administration,...
Objective:
To evaluate the effects of artesunate on organ injury and dysfunction associated with hemorrhagic shock (HS) in the rat.
Background:
HS is still a common cause of death in severely injured patients and is characterized by impairment of organ perfusion, systemic inflammatory response, and multiple organ failure. There is no specific th...
Background:
The aim of this study was to describe the prevalence, patterns of blood use and outcomes of major haemorrhage in trauma.
Methods:
This was a prospective observational study from 22 hospitals in the UK, including both major trauma centres and smaller trauma units. Eligible patients received at least 4 units of packed red blood cells (...
Background
Tranexamic acid (TXA) in traumatic haemorrhage reduces death from bleeding. However, its effect on the coagulation system after trauma is unclear. We aimed to assess the effect of TXA on functional clotting dynamics in patients with suspected traumatic haemorrhage.
Methods
Adult trauma patients for whom the major haemorrhage protocol wa...
https://www.nice.org.uk/guidance/ng39
Background:
Measurement of long term health outcome after trauma remains non-standardised and ambiguous which limits national and international comparison of burden of injuries. The World Health Organisation (WHO) has recommended the application of the International Classification of Function, Disability and Health (ICF) to measure rehabilitation...
The purpose of this study was to re-evaluate findings of a smaller cohort study on the functional definition and characteristics of acute traumatic coagulopathy (ATC). We also aimed to identify the threshold values for most accurate identification of ATC and prediction of massive transfusion (MT) using rotational thromboelastometry (ROTEM) assays....
Purpose of review:
Trauma-induced coagulopathy (TIC) is a multifactorial, global failure of the coagulation system to sustain adequate haemostasis after trauma haemorrhage. Damage control resuscitation is associated with improved outcomes although the mechanisms of how it corrects TIC have yet to be fully characterized. Identification of predomina...
BACKGROUND:
Posttraumatic nosocomial pneumonia is a common complication resulting in significant morbidity. Trauma-induced immunocompromise is associated with an enhanced susceptibility to pneumonia. In this study, we explore the hypothesis that posttranscriptional epigenetic regulation of gene expression may be an important factor in determining t...
Objectives:
To evaluate the impact of the implementation of an inclusive pan-regional trauma system on quality of care.
Background:
Inclusive trauma systems ensure access to quality injury care for a designated population. The 2007 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found quality deficits for 60% of severely in...
Objectives:
To characterize and evaluate indications for use of damage control (DC) surgery in civilian trauma patients.
Background:
Although DC surgery may improve survival in select, severely injured patients, the procedure is associated with significant morbidity, suggesting that it should be used only when appropriately indicated.
Methods:...
Background:
The use of abbreviated or damage control (DC) interventions may improve outcomes in severely injured patients when appropriately indicated. We sought to determine which indications for DC interventions have been most commonly reported in the peer-reviewed literature to date and evaluate the opinions of experts regarding the appropriate...
Introduction:
A proportion of trauma patients are thought to develop persistent immunosuppression and inflammation, manifesting as prolonged patterns of multi-organ dysfunction (MOD). We aimed to evaluate MOD patterns in relation to admission variables and outcomes in trauma haemorrhage.
Methods:
Trauma patients recruited into the 'Acute Coagula...
Introduction:
Persistent lymphopenia several days after admission is associated with increased mortality in septic and severely injured patients. We hypothesised that severe abnormalities of the lymphocyte count in the early stages of critical illness are associated with poor outcome in emergency general surgical (EGS) patients.
Methods:
We perf...
Introduction:
Venous thromboembolic events (VTE) occur in up to 20% of trauma patients and of these, pulmonary embolus is fatal in up to 50%. It is unknown whether fibrinolytic activation and consumption of precursors may subsequently render patients hypercoagulable. We hypothesised that an early hyperfibrinolytic state would lead to a propensity...
Introduction:
Tranexamic acid (TXA) in traumatic haemorrhage reduces death due to bleeding. However, its exact mechanism of action in trauma is unclear. We investigated the effect of TXA on functional clotting dynamics.
Methods:
Prospective cohort study of 102 adult trauma patients activating the major haemorrhage protocol within a single level-...
Introduction:
Mass casualty events (MCEs) generate a surge in severely injured bleeding casualties requiring rapid resuscitation primarily through high volume red blood cell (RBC) transfusion to maintain end organ perfusion. The significant RBC demand of these events threatens to overwhelm in-hospital RBC supplies. We investigated transfusion base...
Introduction:
There is increasing evidence for the existence of a Trauma-Induced Secondary Cardiac Injury (TISCI), which, with resultant cardiac dysfunction, contributes to late mortality and morbidity in severely injured patients. The aim of my study was to demonstrate that cardiomyocyte injury induced by trauma, reflected by H-FABP, correlates w...
Introduction:
Hemorrhagic shock (HS) is a common cause of death in severely injured patients and is associated with impairment of organ perfusion, systemic inflammatory response and multiple organ failure. The aim of the present study was to evaluate the effects of artesunate, the drug of choice for the treatment of falciparum malaria, on organ in...
