Trauma
KADOORIE CENTRE
FOR CRITICAL CARE
RESEARCH AND
Research & Development
EDUCATION
V O L U M E
OUR RESEARCH
THEMES
6 ,
I S S U E
treatments
Rehabilitation
Patient / Staff
experience
INSIDE
THIS
ISSUE:
Predicting
Multiple Organ
1
SWIFFT
1
Ankle Injury
management
2
PROhip Advisory
Group
2
SCI - POEM
2
Young
3
Investigator Prize
FixDT
3
Forthcoming
Meetings
3
Contact details
4
Selected
References
4
F E B R U A R Y
2 0 1 4
Predicting Multiple Organ Failure
Predicting multiple organ
failure after major trauma
- Lynn Hutchings
Effectiveness of
1
Over the past three years, we
have been working on building
a trauma database to provide
extensive information about
the most severely injured
trauma patients. Data from
this was analysed to find risk
factors for the development
of multiple organ failure
(MOF) after trauma. For the
severely injured, MOF occurs
in between 20 and 70% of
patients, depending on its
definition. Using statistical
models involving combinations
of clinical variables, MOF could
be predicted with good
accuracy from 2 hours after
injury. Risk factors depend on
the MOF definition and the
time from injury.
We have shown that currently
patients who develop MOF
reach the intensive care unit
(ICU) later than those that do
not, suggesting we are not
accurately assessing clinical risk
for individual patients. The
improved knowledge of MOF
risk factors gained from this
study will help with the
development of a clinical risk
score to assist in patient
assessment. Importantly, we have
identified areas where potential
interventions can be targeted to
try to reduce MOF risk. We
have also shown that the
definition of MOF must be
standardised to allow meaningful
comparisons between groups of
trauma patients.
Lynn Hutchings
SWIFFT
Fracture of the scaphoid
bone is the most common
type of wrist fracture. It is
an important public health
problem as it affects young
active individuals and
impacts on their ability to
work.
Recent systematic reviews
have found insufficient
evidence from trials to
inform clinical decisions. In
spite of this there is a
rapidly increasing trend for
immediate surgical fixation
of these fractures.
SWIFFT is a multi-centre
randomised controlled trial
evaluating cast treatment
versus surgical fixation on
wrist function for fractures
of the scaphoid waist in
adults. The study’s primary
outcome measure is the
Patient Rated Wrist
Evaluation – a patient
reported outcome measure
assessed at baseline, 6, 12,
26 and 52 weeks, and 5
years.
Secondary outcomes will
include an assessment of
radiological union (healing),
recovery of wrist range and
strength, return to work
and recreational activities. In
addition complications such
as infection will be collected
and a detailed economic
analysis to investigate the
cost-effectiveness of both
treatments will be
undertaken. The study also
explores patient experience
of fracture and its treatment;
and will investigate the
experience of participating in
a surgical trial. The trial will
undertake a 5 year clinical
review of all participants to
determine the long-term
consequences of cast
immobilisation and internal
fixation.
The study opened in Oxford
in February 2014 and will
close in March 2016. Mr Ian
McNab is the Principle
Investigator.
Contact: Louise Spoors/
Susanna Symonds
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AIM: Update
The AIM Trial achieved its
recruitment target in
November 2013, ahead of time.
525 participants were
recruited, 42 from the John
Radcliffe Hospital who were
our second highest recruiters!
Study follow up appointments
continue into 2014, with
extended postal follow up
continuing into 2016.
The main study results will be
available in early 2015.
Our gratitude to all who have
contributed.
If you would like to know more,
please contact the AIM Trial Office:
The Health Technology
Assessment Programme is
funding both the main study and
the extended follow up.
Tel: 01865 740328 or
aim.trial@ndorms.ox.ac.uk Lesley
Morgan, AIM Trial Manager
PROhip Advisory Group
Patient Important Outcomes
for Hip fracture
Liz Tutton, Bob Handley, Jo Brett, Kirstie
Haywood, Mary Dennett, Pat Williams,
Julie Wright
The final advisory group for the
PROhip study took place in
October at the Kadoorie Centre.
The group comprised of clinical
staff from the Trauma Unit, patient
representatives who had
experienced hip injuries and
researchers from the Royal College
of Nursing Research Institute. Jo
Brett presented the findings from the
experience of hip fracture study and
Kirstie Haywood presented findings
from the review of hip fracture
outcomes. Publications are underway
and Jo and Kirstie have presented at
several conferences. Additional group
members not in the photograph are
Ade Adebajo, Debbie Langstaff,
Sophie Staniszewska and Glynne Butt.
SCI - POEM
Prognostic Factors and
Therapeutic Effects of Surgical
Treatment for Traumatic Spinal
Column Injury with Spinal Cord
Injury: A Prospective,
Observational European Multicentre (SCI-POEM Study).
The role of early surgical
treatment in the management of
patients who sustain a traumatic
spinal cord injury (tSCI) has
been one of the most debated
topics in the management of
tSCI for many years. However,
despite years of discussions and
research, no conclusive data
related to the role of the timing
of decompressive surgery (of
the spinal cord and column)
have been published to date.
SCI-POEM is designed to
evaluate the effectiveness of
early surgical treatment for
patients who sustain a tSCI.
functional activities are secondary
outcomes of interest.
In 12 European trauma centres
across Europe – including 3 UK
Trauma centres – outcomes will
be compared between SCI
patients who undergo acute (<12
hours) and non-acute (>12 hours,
<2 weeks) surgical treatment of
the injured spine. This is an
observational comparative study
design.
The study is funded by the AO
Foundation and sponsored by
Norfolk and Norwich University
Hospital NHS Trust. Portfolio
status has been adopted as a non
commercial study.
The primary objective of the
study is to investigate the
difference in the neurological
outcomes between the two
groups by measuring the change
in muscle strength of the legs
between the time before surgical
treatment and 1 year later. Other
neurological outcomes and daily
The study is anticipated to be
open for recruitment for 3 years
with hopefully 300 patients
included.
Oxford is one of the UK sites for
this study and we hope to start to
recruit shortly. Our principal
Investigator is Mr Jeremy
Reynolds. We are expected to
recruit one patient per month.
Contact: Louise Spoors
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Young Investigator Prize
Joseph Alsousou, an orthopaedic
surgeon and clinical research
fellow at Oxford University
Hospitals Trauma Unit/University
of Oxford (Nuffield Department
of Orthopaedics, Rheumatology
and Musculoskeletal Sciences),
won Arthritis Research UK’s first
Young Investigator prize for
Orthopaedic Surgeons.
The award recognises his work on
platelet-rich plasma in Achilles
tendon healing.
He was presented with the
Award and Prize at the British
Orthopaedic Association annual
scientific congress where he also
presented his work.
Contact: Joseph Alsousou
With his prize money he was able
to attend the American Academy of
Orthopaedic Surgeon’s annual
meeting in Chicago where he
presented his research to an
international audience.
Joseph Alsousou
FixDT
The UK Fixation of Distal Tibial
Fracture. This is a multi-centre
randomised control trial currently
open in 13 sites investigating
different methods of surgically
treating fractures of the lower shin
bone. Oxford opened in late
December 2013 as part of the main
phase of the study. The Research
Question asks: For patients with a
displaced fracture of the distal
tibia, is there a clinical and costeffectiveness difference
between ‘locking’ plate fixation
and intramedullary (IM) nail
fixation?
The recruitment target is 320
participants; 0.75 expected per
month at each site. There is a
one year follow up period and
the study closure date is
February 2017. This study is
funded by the Health
Technology Assessment Board
and sponsored by the
University of Warwick and
University Hospitals Coventry
and Warwickshire NHS trust.
The Primary Outcome Measure
is the Disability Rating Index
which is filled out by the patient.
It consists of 12 items specifically
related to function of the lower
limb. Those eligible for the study
include: >16yrs with a fracture
involving the distal tibia
metaphysis (within 2 Muller
squares of ankle joint - as
indicated in diagram) and suitable
for either the locking plate or IM
nailing. The fracture must not
involve the ankle joint or be an
open fracture. We have
recruited our first patient for
this trial.
Contact: Louise Spoors
Forthcoming Meetings
Injuries and Emergencies
Speciality Group (IESG) is
part of the Thames Valley
Comprehensive Local Research
Network (TVCLRN). Chairman:
Mr Andrew MacAndrew.
Next meetings:
Friday 28th March at SCAS,
Bicester and Friday 27th June at
the John Radcliffe Hospital.
Lunch at 12.30pm, meeting 1.303pm.
Trauma Orthopaedic
Research Collaboration
(TORC): This is a national
meeting attended by a mixture of
Trauma, Ortho-geriatric and
Bone & Metabolic Health
specialists and multidisciplinary
staff.
Chairman: Tim Chesser
Next Meetings:
May 9th, July 18th, October 3rd. All
currently in Oxford until Bristol
relocation becomes clearer.
Meeting 11am - 2 pm.
Contact: Louise Spoors/Susanna
Symonds
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Kadoorie Centre
for Critical Care Research and Education
Email addresses
josephalsousou@doctors.org.uk
Level 3
John Radcliffe Hospital
chris.bouse@ouh.nhs.uk
Oxford
lynn.hutchings@ndorms.ox.ac.uk
OX3 9DU
david.keene@ndorms.ox.ac.uk
s.lamb@warwick.ac.uk
sally.lambert@ouh.nhs.uk
debbie.langstaff@ouh.nhs.uk
Contact: Chris Bouse
Phone:
lesley.morgan@ndorms.ox.ac.uk
01865 223101
emma.roberts@ndorms.ox.ac.uk
01865 223103
Fax:
www.ouh.nhs.uk/kadoorie/
01865 223102
louise.spoors@ouh.nhs.uk
susanna.symonds@ouh.nhs.uk
liz.tutton@ouh.nhs.uk
keith.willett@ndorms.ox.ac.uk
julie.wright@ouh.nhs.uk
Selected Recent References
Hamilton, T., Hutchings, L., Alsousou,
J., Tutton, E., Hodson, E., Smith, C.H.,
Wakefield, J., Gray, B., Symonds, S.,
Willett, K. (2013) The treatment of
stable paediatric forearm fractures
using a cast that may be removed at
home. Comparison with traditional
management in a randomised
controlled trial. The Bone and Joint
Journal, doi: 10.1302/0301620x95B12.31299 Vol95B:1714-20.
Barker, KL., Javaid, MK., Newman,
M., Minns Lowe, C., Stallard, N.,
Campbell, H., Gandhi, V., Lamb, S.
(2014) Physiotherapy Rehabilitation for
Osteoporotic Vertebral Fracture
(PROVE): study protocol for a
randomised controlled trial. Trials. Jan;
1(15): 22. doi: 10.1186/1745-6215-1522
Cole, E., Davenport ,R., Willett ,K.,
Brohi, K. (2014) The burden of
infection in severely injured trauma
patients and the relationship with
admission shock severity. J Trauma
Acute Care Surg. Jan. doi: 10.1097/
TA.0b013e31829fdbd7
Knox, CR., Lall, R., Hansen, Z., Lamb,
SE. (2014) Treatment compliance and
effectiveness of a cognitive behavioural
intervention for low back pain: a
complier average causal effect approach
to the BeST data set. BMC
Musculoskelet Disord. 1(15): 17. doi:
10.1186/1471-2474-15-17
Useful Links
The Comprehensive Clinical Research Network: www.crncc.nihr.ac.uk/about_us/ccrn
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences:
www.ndorms.ox.ac.uk
Injury Minimization Programme for Schools (I.M.P.S.): www.impsweb.co.uk
University of Oxford: www.ox.ac.uk