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The Harsh Reality: trauma can hit anyone

The upper half of a person, showing the internal organs through an opaque skim layer

At present, there is no cure for multiple organ failure. Many trauma patients who survive the initial injury often develop organ dysfunction later on due to the damage caused to the body. New research is looking at ways to predict the onset of multiple organ failure and possible treatments.

Trauma in its widest sense is a disease caused by physical injury to the body. This may be blunt such as road traffic accidents and falls from height or penetrating through stabbings and gun shootings. Trauma is one of the greatest causes of death and disability in the UK, claiming up to 17,000 lives every year. It kills more people under 44 than all other causes combined; including heart disease, cancer and meningitis.

Annually, in the UK, trauma cases lead to 720,000 hospital admissions and 6 million visits to emergency departments. Therefore, trauma is a serious public health problem, with substantial economic and social costs, in addition to its impact on individuals and families. In contrast to most other diseases, instances of trauma and the accompanying mortality rates are increasing. Since the beginning of the COVID-19 lockdown, injuries and deaths due to trauma have dramatically decreased; however, they are expected to rise again once lockdown is lifted.

Research remains important. If someone is severely injured, there is a 1 in 3 chance they are going to die and for every one person that dies, there are up to four people who are left severely disabled; resulting in them being dependent on their family or society and with a relatively poor quality of life. Trauma research is helping to better inform our understanding of how the body responds to physical injury, leading to improvements and innovations in resuscitation, surgery and intensive care.

Trauma cases lead to 6 million visits to emergency departments every year in the UK.

An ambulance

Since 2012, at least 600 people in London have survived traumatic injury due to research and innovation. Overall, the survival rates have doubled in the last ten years due to trauma research that guides improved treatments and medical advances. However, trauma research is desperately under-funded, despite it being one of the most crucial ways in which more lives could be potentially saved. Less than 1% of medical research funding is spent on trauma research in spite of the high number of cases.

Trauma-associated blood loss is frequently considered the biggest cause of preventable deaths in the world. Half of all trauma fatalities are attributed to bleeding. More than 2.5 million people a year worldwide bleed to death from their injuries. Trauma patients who survive the initial injury often develop multiple organ failure at a later stage owing to the damage inflicted on the body. Multiple organ failure gives rise to the need for prolonged intensive care support, increases the risk of complications and can worsen long-term outcomes or increase the likelihood of late phase deaths. Further investigating the mechanisms by which the body suffers organ failure following trauma allows the development and testing of new treatments and therapeutic approaches.

Currently, there are no specific treatments or approaches which prevent multiple organ failure or decrease the extent of organ injury in trauma patients. My research aims to study the use of various compounds. We model the effect of trauma-associated blood loss using rats* and examine what effect, if any, the compounds have on organ injury and dysfunction. This is done by collecting a blood sample, as would be done with humans, and performing different tests. The results of these blood tests give an indicator as to whether organ damage has occurred and if the experimental compound has improved the organ condition; by comparing rats that have been given the compound against those given a placebo.

The organs which I focus on in particular are the liver, kidneys, heart, pancreas and lungs. An interesting finding is that the blood test results in rats subjected to blood loss show a similar pattern to human trauma patients (based on previous research studies). For example, an increase in waste products that would normally be removed in the urine is a sign of kidney damage and has been observed in both rats and humans. This increases our confidence that what is seen in the rat model is also applicable to humans.

An illustration showing the internals of a human body. Labelled are thyroid, heart, stomach, kidneys, bladder, intestines, liver and lungs

If the results of my experiments demonstrate an improvement in organ function, this can form the basis of future follow-up studies both in rats and humans. This would be exciting to see research being translated from bench to bedside. Whilst it would be extremely difficult to eradicate all trauma-related injuries and deaths, identifying treatments that lower the incidence and severity of multiple organ failure following major blood loss could have a significant global impact on patient prognosis and the allocation of key resources.

* The rats are carefully looked after with a healthy diet, plenty of toys and daily cuddles. The experiment simulates the effects of human blood loss caused by trauma. A small amount of blood is withdrawn from a rat to lower their blood pressure. This lower blood pressure is maintained for a short period of time. The blood is then reinfused back into the rat, like a blood transfusion. The rat is subsequently monitored for any side-effects. The translation in a human would be the length of time taken for the emergency services to arrive and take the person to hospital for treatment.

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Nikita Patel
Full-time PhD Student (Non-clinical) The William Harvey Research Institute, Queen Mary University of London

Nikita Patel

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