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Golden Hour Study Details Earliest Changes to the Immune System After Trauma

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In order to improve the outcomes for patients who have experienced traumatic injury, a pioneering research is being carried out by the researchers from the University of Birmingham. This study is a part of the major £10 million study is known as the ˜Golden Hour' study.

The Golden Hour study was launched in the year 2014 and is carried out over a four year period. The term ˜golden Hour' refers to the first 60 minutes from the time a person suffers a traumatic injury. This time is very crucial as a prompt and right medical analysis and treatment during this period is an important factor for the patient's survival. The aim of the study is to understand what happens to the immune system in this 60 minutes window. Insights into the happening can play a big role in managing such cases.

The study is being led by Professor Janet Lord and Professor Tony Belli from the University of Birmingham’s Institute of Inflammation and Ageing and the National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR SRMRC) respectively. A key piece of the research of the ongoing Golden Hour study was published in PLOS Medicine on 18th July 2017.

It is seen that the major and instant cause of the death after a severe trauma is hemorrhage remarked Lead author Dr. Jon Hazeldine, a Research Fellow at the University of Birmingham However, in some cases where the victim dies later complications like multi-organ dysfunction or sepsis are the causes of death. It means that the individual’s immune response to injury greatly influences the chances of developing these fatal conditions.

He added that in most studies that have studied the immune response to trauma, blood samples taken after hospital admission have been analyzed. So, there is no information about the immune status of the patient right after the injury and how it might have any influence on the outcome for the patient.

Dr Hazeldine further adds that the aim of the study is to comprehensively assess the ultra-early immune response to trauma. The exploratory analysis then needs to be carried out to find its relationship with the development of multiple organ dysfunction syndromes.

An important part of the research was the blood sampling and analysis operation working 24 hours a day in collaboration with West Midlands Ambulance Service and Midlands Air Ambulance. Paramedics who are specially trained in taking blood samples from such patients are immediately sent to the scene of such major traumas.

Professor Janet Lord explained that even before this study, it was known that a few days after major trauma the immune system is much suppressed, and it makes the patient very prone to infections and sepsis. However, it wasn't known how soon it happens. This study has now revealed that the changes to the immune system happen fast. In fact, within minutes of a traumatic injury, the levels of many immune cells and molecules are altered in the patient. It is also interesting to note that in some cases these immune cells and molecules increase than normal and in some cases they decrease.

Professor Janet Lord added that it was known that after a traumatic injury activation of the immune system happened and also compensatory response starts in a bid to dampen down the inflammation. This study showed us that these processes don't happen sequentially but simultaneously.

As a part of their study, the composition and function of immune cells and concentrations of cytokines, in blood samples acquired within one hour from 89 adults who suffered traumatic injuries was analyzed. Again blood samples were taken at four to 12 hours and 48 to 72 hours post-injury and were analyzed.

Professor Tony Belli explained that it was seen that many characteristics of the immune reaction observed in the first hour were different from those seen at later time points. Also, a link between natural killer T cell numbers in the hour after trauma and the eventual development of multiple organ dysfunction syndromes was found.

The researchers are now hopeful that their findings will help them to develop a test to determine which patients have a response that makes them likely to get to sepsis or multiorgan failure. This test will help in identifying such cases so that treatment can be started early.