Inflammation and the Host Response to Injury (Trauma)
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Purpose
The purpose of this study is to help improve our understanding of the biology involved in the body's response to serious trauma or burn injury. The host response to trauma and burns is a collection of physiological and pathophysiological processes that depend critically upon the regulation of the human innate immune system, with particular emphasis on the inflammatory component of that system. No single research center or small group of centers has the capacity to delineate the integrated response of this complex biological system, which involves multiple molecular and genetic interactions that vary in time. Our proposal promotes the identification of important dynamic relationships that regulate the integration of this complex biological system, with the expectation that this understanding will ultimately impact the diagnosis, prognosis, and treatment of the hospitalized, severely injured patient.
| Condition |
|---|
|
Trauma Burns Multiple Organ Failure |
| Study Type: | Observational |
| Study Design: | Observational Model: Cohort Time Perspective: Prospective |
| Official Title: | Inflammation and the Host Response to Injury |
- Time to death [ Time Frame: Within 28 after trauma injury ] [ Designated as safety issue: No ]
- Change in gene expression after trauma injury [ Time Frame: Up to 28 days after trauma injury ] [ Designated as safety issue: No ]
- Number and types of complications [ Time Frame: Up to 28 days after trauma injury ] [ Designated as safety issue: No ]
Biospecimen Retention: Samples Without DNA
Plasma, blood leukocyte nucleic acids (only RNA, no DNA)
| Estimated Enrollment: | 610 |
| Study Start Date: | November 2003 |
| Estimated Study Completion Date: | September 2013 |
| Estimated Primary Completion Date: | September 2013 (Final data collection date for primary outcome measure) |
This large-scale collaborative project provides the means to acquire the necessary new knowledge directly in humans. Knowledge will be acquired using diverse state-of-the-art genomic and proteomic technologies, a highly complex clinical, proteomic, and genomic database, as well as newly-developed, novel analytical tools to probe this complex dataset. Our analytical capabilities at the genomic and proteomic level are now rapidly evolving and our ability to link these genomic and proteomic data to pathways and functional modules will help us more closely link this cellular data to immunological processes and ultimately, to the phenotypic response (i.e., trajectory) in the injured host. As a result, potential interventions, whether through our Program or other funding mechanisms, can be more effectively designed.
Eligibility| Ages Eligible for Study: | 16 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Non-Probability Sample |
Acute hospitalized blunt trauma patients
Inclusion criteria for enrollment in the trauma study are as follows:
- Blunt trauma without isolated head injury
- Absence of traumatic brain injury, defined as either AIS head <4 OR GCS motor >3 within 24 hours of injury
- Emergency Department arrival <=6 hours from time of injury
- Blood transfusion within 12 hours of injury
- Base deficit >=6 OR systolic blood pressure <90 mmHg within 60 minutes of emergency department arrival
- Fully or partially intact cervical spinal cord
All patients meeting these criteria are entered into the epidemiologic database and assessed for specific exclusion criteria to establish whether serial blood draws are warranted.
The presence of any of the following exclusion criteria disqualifies a subject from the trauma sampling study.
- Age < 16
- Anticipated survival of <24 hours from injury
- Anticipated survival <28 days due to pre-existing medical condition
- Inability to obtain first blood draw within first 12 hours after injury
- Traumatic brain injury; i.e., GCS ≤8 after ICU admission AND brain computerized tomography scan abnormality within 12 hours after injury
- Inability to obtain informed consent
- Pre-existing, ongoing immunosuppression - e.g. transplant recipient
- Pre-existing, ongoing immunosuppression - e.g. chronic high dose corticosteroids (>20 mg/prednisone-equivalents/day)
- Pre-existing, ongoing immunosuppression - e.g. oncolytic drug(s) therapy within the past 14 days
- Pre-existing, ongoing immunosuppression - e.g. HIV positive AND CD4 count <200 cells/mm3
- Possible requirement for early immunosuppression - e.g. significant likelihood of requiring high dose corticosteroids (e.g. spinal injury)
- Significant pre-existing organ dysfunction - lung: currently receiving home oxygen therapy, as documented in medical records
- Significant pre-existing organ dysfunction - heart: congestive heart failure, as documented in medical records
- Significant pre-existing organ dysfunction - renal: chronic renal failure (creatinine >2)
- Significant pre-existing organ dysfunction - liver: cirrhosis with portal hypertension or encephalopathy
- Patient injured while sampling enrollment temporarily on hold
Contacts and Locations| United States, Colorado | |
| Denver Health Medical Center at University of Colorado | |
| Denver, Colorado, United States, 80204 | |
| United States, Pennsylvania | |
| Presbyterian University Hospital at University of Pittsburgh | |
| Pittsburgh, Pennsylvania, United States, 15213 | |
| United States, Texas | |
| Southwestern Medical Center at University of Texas Southwestern | |
| Dallas, Texas, United States, 75390 | |
| United States, Washington | |
| Harborview Medical Center | |
| Seattle, Washington, United States, 98104 | |
| Principal Investigator: | Ronald G Tompkins, MD, ScD | Massachusetts General Hospital/Shriners Burn Hospital - Boston |
More Information
Additional Information:
Publications:
| Responsible Party: | Dr. Ronald G Tompkins, Chief, Burns Service, National Institute of General Medical Sciences (NIGMS) |
| ClinicalTrials.gov Identifier: | NCT00257231 History of Changes |
| Other Study ID Numbers: | 2 U54 GM062119_trauma, NIH 2 U54 GM062119 |
| Study First Received: | November 18, 2005 |
| Last Updated: | June 5, 2013 |
| Health Authority: | United States: Institutional Review Board United States: Federal Government |
Keywords provided by National Institute of General Medical Sciences (NIGMS):
|
Immunity, innate Inflammation Genomics Proteomics |
Additional relevant MeSH terms:
|
Inflammation Multiple Organ Failure Wounds and Injuries Pathologic Processes Shock |
ClinicalTrials.gov processed this record on June 18, 2013