TBI is a leading cause of death and disability worldwide; over 50 million people have a TBI each year and global incidence is rising. Long-term impacts from TBI are complex, heterogeneous, and include physical, psychological and cognitive sequelae. One method of systematically capturing patients’ own health perspectives is through the use of PROs. These are questionnaires completed by patients to measure their own estimation of health using domains such as symptoms, mobility, mental health, quality of life, and social functioning. Prior to this study, we conducted qualitative research which explored the attitudes of healthcare providers, researchers, patients and carers towards capturing long term impacts and reporting residual symptoms on an electronic platform. We found PROs were seen as helpful to clinicians and patients as they improved knowledge of residual symptoms and their impact post-TBI. The participants’ positive attitudes towards an electronic platform to collect PROMs show that there is a demand for reporting their symptoms and their impact electronically. Subsequently, we will explore the usability and feasibility of an ePRO system for patients with TBI.

Method

We will test the usability and acceptability of an ePRO platform with TBI patients. Usability and acceptability will be evaluated using quantitative and qualitative methods: including questionnaires, “think aloud” feedback, task completion times, and error rates.

We will test the feasibility of collecting ePRO data in an outpatient clinic at University Hospital Birmingham.

When managing patients with critical illness including sepsis and hypovolaemic shock it is vital that perfusion of critical end organs including the heart and brain are monitored.  Existing global perfusion measures include blood pressure and venous lactate.  Local measures include urine output.  Research measures include cerebral near-infrared spectroscopy, which may be useful for serial monitoring but is very variable between individuals and sublingual dark field microscopy which assesses local microcirculatory changes that may indirectly correlate with end-organ perfusion. The neuro-retina is part of the central nervous system and in healthy individuals, retinal perfusion mirrors cerebral perfusion and is subject to the same auto-regulatory mechanisms.  Retinal perfusion is monitored non-invasively using OCT-A.

Pilot data obtained in the Queen Elizabeth Hospital suggests that OCT-A is a reliable method to assess retinal blood flow on ITU and changes in retinal blood flow may reflect systemic morbidity.

Method

We will recruit patients with scheduled major surgery at risk of sepsis and critical illness and assess retinal blood flow pre-operatively and post-operatively using OCTa alongside other measures of systemic and end-organ perfusion.

Existing practice for managing infections, such as meningitis and encephalitis, relies on either a nucleic-acid amplification test or microbial culture to provide a positive identification. Both these methods are too slow to inform treatment in the early stages. This project aims to replace these methods with an accurate, real-time test that can be performed near the patient. This will allow doctors to prescribe the most suitable drugs e.g. antiviral, antibiotic or antifungal drugs early in the illness improving patient outcomes and reducing recovery time.

Method

This project will enable the real-time diagnosis of infections by detecting pathogen DNA or RNA directly from clinical samples. This relies on an advanced technology known as nanopore sequencing which can analyse single-molecules of DNA or RNA and determine their sequence. This allows us to identify what is causing the infection which may be as virus, bacteria or a fungal pathogen. It also provides information on the type, identification of virulence and antibiotic resistance which will improve the management and treatment of the infection.

Current Injury severity scoring systems initially developed to predict mortality in blunt trauma and then refined to predict all major trauma, are currently understood as having severe limitations in terms of both prediction as well as stratification of major trauma. In addition to that, integration of the multimodal data set a problem due to complex interactions of the inflammation and response to trauma. Our aim is to find a strategy to integrate multiple diverse data sets that can be used as physiological based scoring systems to stratify trauma patients and predict clinical outcomes into the rehabilitation phase of treatment.

Method

Using existing longitudinal physiological, metabolomics, and biochemical data from the SIRS, SIFTI and Golden Hour studies a repertoire of computational biology and systems biology techniques are applied to develop a model of injury that enables the improved stratification of patients. Artificial Intelligence based approaches are applied to cater for the integration of multimodal datasets, from metabolomics to clinical, so as to develop state of the art models from outcome prediction.

Sport-related concussion management remains a diagnostic dilemma to clinicians in all strata of care, coaching staff and players alike. The lack of objective diagnostic and prognostic biomarkers and over-reliance on subjective clinical assessments carries a significant health risk of undiagnosed concussive episodes and early return to play before full recovery increasing the risk of sustaining additional concussion, and leading to long-term sequelae and/or unfavourable outcome. Therefore, a multidisciplinary approach is required to objectively diagnose sport-related concussion and guide a safe return to play following single and repetitive concussions to prevent further complications and long-term sequelae.

Method

RECOS is an observational, prospective, cohort study. A cohort of male or female contact sport athletes (16-65 years) will be recruited throughout the West Midlands region and through referrals from sports clubs anywhere in Great Britain. The participants will have a baseline pre-season screening (brain imaging, neuropsychological assessments, serum, urine and saliva sampling). If a screened player later suffers a concussion and/or multiple concussions then he/she will be assessed again with the same protocol within 48-72h in the Birmingham concussion clinic at QEHB, although attending directly or as soon as is practically possible will be advised. Should the injury be sufficiently serious that the attending staff believes immediate medical assistance or transfer to the nearest emergency department is required, then standard clinical procedures should be followed in these cases.