International Trauma Research Network...
Transcript of International Trauma Research Network...
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International Trauma Research Network (INTRN)
PPhhiill SSppiinneellllaa St Louis
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CLINICAL TRAUMA RESEARCH
‘Noisy’
Volume
Time
Quality
Diversity
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TWO MODELS
Network Formali�es Topic Studies
Topic Formali�es Trial Partners
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The Interna�onal Trauma Research Network (INTRN) was formalised in 2010 INTRN is a collabora�on of academic trauma centres aiming to: maximise the capacity and capability for research in trauma sciences accelerate transla�on of research into evidence-‐based prac�ce, into policy
deliver a coordinated and harmonised approach to an impac�ul por�olio
support the development of researchers in trauma sciences
promote intra-‐ and inter-‐disciplinary sharing of ideas
enable effec�ve dissemina�on of its results
INTRN – what does it want to do?
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STUDY PROTOCOL ACIT III
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Thromboelastography in Trauma Haemorrhage (TEGinTH)
TEGinTH study -‐ 900 pa�ents (2yrs)
$1M funding for INTRN -‐ AMC, OSL, QM (CPH, COL)
Another VHA technique? -‐ Sensi�vity & specificity of TEG assays versus established laboratory measures
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Challenges
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TEG in Trauma Recruitment Oslo
Recruitment per week
Cummula�ve total
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STRUCTURE
ToR
Chair
Communication
Members
Manager
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CHALLENGES
Differences
Logistics
Study personnel
Funding
Data protection
Ethics
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COLLECTION, PROCESSING, TRANSFER AND ANALYSIS OF STUDY MATERIALS
Pa�ent Data
Tissue Local Stores Centralised
Repositories MTA
DUA
INTRN TOR
3rd Party Contracts
CA CA
CA CA
CA
MA
Sponsors
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”When using standard laboratory tests of coagulation, ATC should be defined as an admission PTr > 1.2”
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£38K funding from NHS BT -‐ Trials Coordinator at QMUL
● Feasibility study -‐ Mul�centre, RCT evalua�ng the effects of early administra�on of cryoprecipitate in major trauma�c haemorrhage
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TACTIC: An INTRN initiative
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Targeted Action for Curing Trauma Induced Coagulopathy (TACTIC)
€5.88m European Union Framework Programme 7 (FP7) Health
Star�ng in Nov’13, INTRN will con�nue to work alongside the key industry leads in coagula�on diagnos�cs for this 5-‐year programme to:
1. Compare coagula�on & outcomes in response to different exis�ng transfusion strategies
2. Specify different disease profiles underlying Trauma Induced Coagulopathy
3. Develop personalised strategies for targeted transfusion
4. Compare exis�ng prac�ces with personalised, targeted treatment of coagulopathy
5. Deliver guidelines and support for the clinical management of coagulopathic bleeding
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Platelet function Clot strength (G)
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Predict massive transfusion ?
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Crit Care Med. 2011
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?
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TACTIC The TACTIC research program and work packages (WP) revolves around:
1. An observa�onal study of approximately 2.000 trauma
pa�ents with blood samples, func�onal haemosta�c & clinical data already completed before TACTIC commence (WP3-‐6)
2. A randomized controlled trial where 1.800 trauma pa�ents are screened and 400 randomized to goal-‐directed interven�ons based on TEG/TOTEM vs. standard therapy (WP7-‐9)
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PRACTICE
TRAUMA PATIENT DATA & TISSUES
[WP2]
MOLECULAR PATHOPHYSIOLOGY
[WP4]
DIAGNOSIS [WP5]
EXISTING TREATMENT [WP3]
FUNCTIONAL COAGULATION RESPONSE TO TREATMENT
[WP6]
TREATMENT ALGORITHM
[WP6]
CLINICAL DECISION SUPPORT [WP7]
RANDOMISED CONTROL TRIAL [WP8]
DISSEMINATION [WP9]
PROGRA
MME CO
ORD
INNAT
ION
[WP1
] 60
mon
ths
HEALTH ECONOMICS
POLICY
IMPACT
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TACTIC work packages & timelines
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TACTIC Partners
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