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Improving Outcomes and Saving Blood

Dates: 2008-2013
Funding: NIHR Programme Grant for Applied Research

Professor Karim Brohi, Royal London Hospital; Dr Simon Stanworth, National Blood Service

Information: Helen Campbell, Liz Stokes, Danielle Bargo

Severe bleeding from major injury is life threatening. Bleeding results from damaged blood vessels, but also from impairments of the blood’s own ability to clot, a condition known as coagulopathy. There are no validated tests or markers to diagnose coagulopathy, so treatment with blood transfusion and clotting factors is based largely on clinicians’ beliefs about a patient’s coagulopathic function. Therefore, some patients receive too few blood transfusions and clotting factors, whilst others receive too many, increasing the risk of complications and wasting blood.

This programme of work aims to improve outcomes for bleeding trauma patients, in part by combining early identification of coagulopathy with effective directed therapy.  Each aim of the programme incorporates health economics to explore the costs and health outcomes associated with bleeding trauma patients, and the potential health economic impact of changes in practice.  Firstly a systematic review of the current health economics literature on traumatic coagulopathy and massive transfusion will be conducted.  An audit of patients requiring massive transfusion at hospitals across England and Wales will be used to estimate and extrapolate the total cost of massive transfusion for the NHS as a whole.  A cohort study designed to evaluate the diagnostic accuracy of various point-of-care tests and markers for the immediate identification of coagulopathy will next be performed. Using data from this study, a model will be developed to estimate the cost-effectiveness of various tests and markers for the immediate identification of coagulopathy. This model will be expanded to estimate the lifetime cost effectiveness of the tests and markers for guiding ongoing transfusion therapy. Finally, a sub study led by the Royal London Trauma Research Group and the Institute of Emergency Preparedness will develop a dynamic model of the provision and consumption of blood and transfusion services during a mass casualty event such as the 2005 London terrorist bombings. It is anticipated that the model could be used regionally to plan for mass casualty and disaster events.