Traumatology Research Group
Most of the patients that expire within the first hours of injury bleed to death. In recent years, major changes in resuscitation have been introduced including balanced transfusion strategies. In patients with severe trauma and blood loss, the ability to form blood clots tends to be reduced shortly after the injury, caused by degree of tissue injury and shock. This condition has been named trauma induced coagulopathy (TIC) and is associated with increased morbidity and mortality. Rapid recognition and optimal treatment of TIC are crucial to improve outcome in these patients. As a partner in the international trauma research network INTRN, TIC has become a major research area in the Traumatology Research Group.
Jostein Hagemo defended his PhD-thesis “Trauma induced coagulopathy - early detection and experimental modelling with emphasis on the role of fibrinogen” in 2017. He described some of the early changes in coagulation following injury including how deficiency of the protein fibrinogen is related to mortality and aspects of the value of the Viscoelastic Haemostatic Assays (VHAs) TEG and ROTEM in early identification of TIC and prediction of transfusion requirements.
The multicenter randomized controlled study iTACTIC is an important part of the EU funded FP7 project TACTIC (Targeted Action of the Cure of TIC) run by INTRN with professor Gaarder as the co-chief investigator for the RCT including about 400 patients enrolled at major European trauma centres. iTACTIC compares VHA guided transfusion strategy versus a treatment guided by conventional coagulation tests in haemorrhaging trauma patients. The algorithms used in iTACTIC were the first to be developed based on a large cohort of trauma patients prospectively observed within the INTRN network. Inclusion was completed in 2018. The primary endpoint is the proportion of subjects alive and free of massive transfusion (<10 units red blood cells) at 24 hours. Secondary outcomes include the effect of CCT versus VHA-guided therapy on organ failure, total hospital and intensive care lengths of stay, health care resources needed and mortality. Surviving patients will be asked to complete a quality of life questionnaire at day 90. Results will be published in 2019. Some of the results will be included as part of the PhD project of Kjersti Baksaas-Aasen.
Oslo University Hospital was responsible for the initial and definitive treatment of the majority of the severely injured victims from the twin terrorist attacks on July 22, 2011. The description of the hospital response, specific injury patterns and outcome is the subject of the PhD project of Joakim Jørgensen which also will include an evaluation of the disaster preparedness in Norwegian hospitals.
In his PhD project, Iver Anders Gaski is examining the effect of changes in resuscitation strategies in cohorts of patients with severe pelvic fractures or severe liver injuries. Moreover, the effect of angiographic embolization in patients with grade 4 or 5 splenic injuries will be addressed in an international multicenter randomized controlled study and inclusion started in 2017. The part of the project of Dr. Gaski evaluating the management of liver injuries is connected to the PhD project of Adam Brooks, Nottingham, also included in the portfolio of the trauma research group.
Although trauma are important contributors to morbidity and mortality in childhood and among the elderly, most of the existing body of evidence concerns healthy adults and treatment is guided thereafter. Less is known about the extremes of age, and in his PhD project “Extremes of age; Causality and consequences of trauma in the pediatric and geriatric population”, Amund R. Hovengen aims at increasing our understanding of consequences from trauma in the geriatric and pediatric populations.