Active Projects
ISARIC4C – Coronavirus Clinical Characterisation Consortium, an observational study
ISARIC/WHO Clinical Characterisation Protocol for Severe Emerging Infections in the UK (CCP-UK)
Projects On Hold
ATTEST2 Trial
Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST 2)
BRAINED Study
Molecular and cellular analysis of intracranial tumours
Diagnostics devices play an important part in the clinical assessment of a patient’s health and treatment. The purpose of the study is the evaluation of a new diagnostic platform developed by LumiraDx. The evaluation is focused around various biomarkers useful in the emergency settings.
NOVEL Study
Collection of venous and capillary blood samples for the evaluation of new diagnostic devices for cardiovascular conditions
Assisting in identifying patients with Humeral shaft fractures in the ED by screening.
Giving patient information sheets to introduce the study, so patient has had adequate time to read and make decision about going into the trial before going to the fracture clinic.
HU-FIX Trial
DASH Trial
DASH is a randomised clinical trial investigating a treatment to reverse the effects of blood-thinning medications.
People who develop an Acute Kidney Injury (AKI) often have a poor prognosis and many go on to develop chronic kidney disease (CKD). The recognition that AKI and CKD are linked is recent and the molecular pathways that control the transition from acute injury to chronic disease are not well defined. Currently there are no specific treatments that reduce the risk of progressing to CKD after AKI.
Preliminary investigations (not yet published) suggest that AKI causes sustained activation of the endothelin (ET) system to the long-term detriment of renal and systemic haemodynamic function. These pilot data form the basis of our project that seeks to determine whether the ET system is active in patients with AKI and, thus, represents a potential target for therapeutic intervention.
KRAKIL aims to recruit altogether 100 patients from across the emergency department, acute medical unit and inpatient wards at the Royal Infirmary. 50 of which with AKI’s and 50 matched controls with normal kidney function. We will monitor their bloods and urine for 90 days and compare the data from between the two groups.
KRAKIL Study
Trauma remains a major cause of mortality and morbidity. 10% of blunt force trauma patients admitted to a major trauma centre will have sustained one or more fractured ribs, which may cause significant pain and problems with breathing.
To establish the outcome of rib fractures and their treatments it is important to know what to measure, and how to measure this accurately. A patient reported outcome measure (PROM) is a questionnaire used to measure patient reported outcomes, to show how the patient is doing from their perspective.
Whilst there is ongoing interest in surgery to fix broken ribs, there is no PROM specifically designed for patients with broken ribs following chest trauma. Therefore, it is not clear whether the symptoms that are most important to these patients are being represented by the current outcome measures. This study aims to create a PROM specific to rib fracture patients to give us a better understanding of whether a new treatment actually makes a difference to the patient’s recovery.
The 1st part of the study involves asking patients with rib fractures to help design a new PROM. This will be conducted through focus groups at a site in Nottingham. The 2nd part of the study entails field testing, whereby patients with rib fractures will be asked to test this new PROM. This will be conducted across multiple secondary care settings in the UK, including the Royal Infirmary of Edinburgh. The study is expected to run for approximately 2 years, with recruitment targets of 50 patients for the PROM Creation phase and 250 for the Field Testing phase.
PROM OCTS
Projects Coming Soon
EMBOL1 Study
A Performance Evaluation of The Lumiradx Point of Care D Dimer Assay AS AN Aid in the Diagnosis and Assessment of VTE (EMBOL1)
A performance evaluation study designed to assess the precision and accuracy of the Lumira DX point of care (POC) and C-Reactive (CRP) assay as an aid in the detection and evaluation of infection, tissue injury and inflammatory disorders.
In the emergency department (ED), CRP is tested in patients presenting with a variety of symptoms as an aid the detection and evaluation of infection, tissue injury or inflammatory disorders.
Primary objective - To determine the performance of the LumiraDx POC CRP assay when compared to the Siemens Dimension reference method in patients with symptoms of infection, tissue injury and inflammatory disorders.
Sample size - 50 participants over a duration of approximately 4 weeks.
REACT Study
Closed Projects
Evaluating the feasibility and safety of implementing a restrictive versus liberal red blood cell (RBC) transfusion policy.
TRIGGER
Transfusion in Gastrointestinal Bleeding
To explore the time taken for research nurses to recruit patients in an Emergency Department (ED) setting.
Time and Motion
Time and Motion
Assesing the effectiveness ondansetron at reducing nausea and vomiting in patients treated with regimen for paracetamol poisoning
SNAP Trial
Scottish and Newcastle Anti-emetic Pre-treatment for Paracetamol Poisoning Study
Developing a Clinical Decision Rule for patients presenting with syncope to the Emergency Department
ROSE
Risk Stratification Of Syncope in the Emergency department
Evaluating the efficacy, safety and tolerability of Serelaxin when added to standard therapy in acute heart failure patients (CRLXA).
Relax 2 Trial
Evaluating Serelaxin in acute heart failure patients
Randomised Assessment of Treatment using Panel Assay of Cardiac markers - a trial of rapid blood testing for acute chest pain in six NHS hospitals around the UK.
RATPAC
Assesing rapid blood testing for acute chest pain
Detection of physiological deterioration by the SNAP40 wearable device compared to standard monitoring devices in the Emergency Department
SNAP40 Study
Evaluating the role of ambulatory, wireless vital sign monitoring in the detection of deterioration
PREFER
Prefer in VTE Prevention of Thromboembolic Events
Determining whether an agreement between peripheral venous and arterial lactate exists in patients presenting to an Emergency Department with sepsis.
LAVAS Study
Lactate, Arterial and Venous Agreement in Sepsis
A randomised controlled trial assessing patient outcomes before and after the implementation of high sensitivity Troponin assay
HighSTEACS
Assessing the implementation of high sensitivity Troponin assay
PATCH-ED
Diagnostic yield of an ambulatory patch monitor in ED
Tranexamic acid for the treatment of gastrointestinal haemorrhage: an international randomised, double blind placebo controlled trial
Halt-It Trial
Tranexamic acid for the treatment of gastrointestinal haemorrhage
Global Anticoagulant Registry in the FIELD observing treatment and outcomes in patients with treated acute Venous Thromboembolic Events in the real world
Garfield-VTE Study
Global Anticoagulant Registry In the FIELD – Venous Thromboembolic Events
Code Red
Transfusion and Laboratory support in Trauma Group Code Red Audit
To derive a biomarker to allow the identification of patients with confirmed sepsis, and risk stratify patients at risk of developing severe sepsis
ExPRES SEPSIS
Early Prediction of Severe Sepsis
TICH 2 Trial
Tranexamic Acid for Hyperacute Primary IntraCerebral Haemorrhage
To co-ordinate and support RIE ED Emergency Transfusion research and audit and disseminate our findings
Blood Project
The Edinburgh ED Blood Project
EURODEM
The European Dyspnoea survey in the Emergency departments
While considerable efforts have been made to determine the best ways to perform cardiopulmonary resuscitation (CPR) for persons suffering an out-of-hospital cardiac arrest (OHCA), and also to understand what the physical and psychological impact on the victim might be, very little is known about what actually occurs when a lay bystander is suddenly confronted by someone in cardiac arrest.
First “First Responder” Study
The First “First Responder”: Understanding bystander actions, experience, and well-being in out-of-hospital cardiac arrest
TPTIH
The Pharmacogenetics of Thiazide Induced Hyponatraemia
POEM
Prescription of Analgesia in Emergency Medicine (POEM)
Is Rotational Thromboelastometry (ROTEM) useful to detect Occult Coagulopathy in the Emergency Department?
DEUCE
Evaluating Rotational Thromboelastometry (ROTEM) in detecting Occult Coagulopathy
Strokes caused by a clot are described as ischaemic. When patients experience ischaemic strokes they may be eligible for “clot busting” therapy (thrombolysis). Currently thrombolysis has been shown to improve patient outcome after a stroke if administered within the first 4.5 hours after stroke onset. Up to 25% of patients wake up with symptoms of a stroke. This means they have an unknown onset time for their stroke (so called ‘wake up strokes’). With no known onset time, they are ineligible for thrombolysis. This study will investigate how we might determine stroke onset time.
MRI in Acute Stroke
HighSTEACS Bioresource
Determining the feasibility of a study investigating the agreement between capillary and peripheral venous lactate in the Emergency Department
CVLA Study
Capillary and Venous Lactate Agreement
This trial is a two arm, multicentre parallel group, randomised controlled, open label trial comparing intravenous levetiracetam to intravenous phenytoin for the treatment of convulsive status epilepticus (CSE) in children, young people and young adults.
EcLiPSE Trial
Emergency Treatment with Levetiracetam or Phenytoin in Status Epilepticus in Children (EcLiPSE) – an open label randomised controlled trial
Intervention
1. Ambulatory Device, Rocket Pleural vent insertion
2. Standard Treatment, Aspiration +/- chest drain
Primary Outcome Measures
To assess whether use of an ambulatory device (Rocket Pleural Vent) and treatment strategy reduces hospital stay. Total length of stay in hospital up to 30 days post randomisation. Up to 30 days post randomisation.
RAMPP trial
RAMPP trial - Randomised Controlled Trial: Pleural vent (rocket) V standard care in Primary Spontaneous Pnuemothorax
This is a study looking at incidence and risk factors for poor ankle functional recovery, and the development and progression of post-traumatic ankle osteoarthritis after significant ankle ligament injury.
SALI Study
SALI study - Significant Ankle Ligament Injury
AHEAD
Monitoring anticoagulated patients who suffer head injury
Patients commonly present to the Emergency Department with epistaxsis (nose bleed). Standard first aid measures such as applying pressure can often stem bleeding however in more severe cases of epistaxsis further treatment is required.
NoPac Trial
Novel Use of Tranexamic Acid to Reduce the Need for Nasal Packing
Evaluating the role of early CT Coronary Angiography on patients with suspected or confirmed Acute Coronary Syndrome.
RAPID-CTCA Trial
Evaluating the role of early CT Coronary Angiography
Continuous positive airway pressure vs non invasive ventilation vs standard therapy for acute pulmonary odema
3CPO Trial
In the Liver Unit at the Royal Infirmary of Edinburgh, we are involved in research to improve the treatment available for people with liver cirrhosis. Cirrhosis of the liver can make people vulnerable to other potentially serious complications including kidney problems.
AKI in LC Study
To produce a predictive tool for HSV encephalitis by comparing those with and without the infection.
ENCEPH UK Study
Understanding and improving the outcome in Encephalitis
Determining the diagnostic accuracy of the 4AT for delirium versus the reference standard of a DSM-IV diagnosis
4AT Study
The 4AT as a triage test for delirium: a validation study in acutely hospitalised older patients
Assessing the effectiveness of IV and nebulised magnesium sulphate in the treatment of acute severe asthma.
3MG Trial
Intravenous or nebulised magnesium sulphate versus placebo for acute severe asthma.
Randomised controlled Trial using smart phone based event recorder technology versus standard care in palpatations or pre-syncope
IPED Trial
Randomised controlled Trial using smart phone based event recorder technology versus standard care in palpatations or pre-syncope
This study contributes to the work of Dr Frank Prior who is developing a tool to be used in the treatment of shock.
It is known that shock creates a set of internal conditions that affect vasculature and that these conditions can vary over time and are dependent on the type of shock. This tool reveals the condition of the vasculature and therefore informs which fluid and drugs are best advised for that patient at that time.
COPS
Calculating Osmotic Pressure in Healthy Patients (COPs)
The study with PP100-01 in combination with NAC is designed to determine safety and tolerability of PP100-01 when co-administered with NAC as compared to the 12-hr NAC treatment regime for patients that come to the hospital after an overdose of paracetamol/acetaminophen.
The POP Trial
A Randomised Open Label Exploratory, Safety and Tolerability Study with PP100-01 in Patients Treated with the 12-hour Regimen of N-Acetylcysteine for Paracetamol/Acetaminophen Overdose
A multi-centre, randomised, double blind, placebo-controlled trial evaluating the effects of early administration of fibrinogen concentrate in adults with major traumatic haemorrhage. E-FIT1 Study
E-FIT1 Trial
A multi-centre, randomised, double blind, placebo-controlled trial evaluating the effects of early administration of fibrinogen concentrate in adults with major traumatic haemorrhage. E-FIT 1 Study
To provide an overview of safety culture and patient safety issues in UK emergency departments, and to determine if there are significant differences between doctors and nurses’ perception of safety issues.
SECUre – A Multicentre Survey of the Safety of Emergency Care in UK Emergency Departments
SECUre – A Multicentre Survey of the Safety of Emergency Care in UK Emergency Departments
This study will investigate how we can help treat patients suffering from shock by the targeted use of specific fluids and medications. Shock is an acute medical condition in which the organs and tissues of the body are not receiving an adequate flow of blood. It is associated with a fall in blood pressure, a build-up in waste products and can result in serious organ damage and even death. We hope to improve our ability to treat shock by evaluating fluid management from the blood samples of a group of healthy volunteers.
The Prior Study
Calculating Osmotic Pressure in Healthy Patients
Traumatic Brain Injury (TBI) is the leading cause of death and disabilities amongst young people worldwide. Many sufferers develop chronic physical and mental health problems and are unable to work or re-engage socially after their injuries. There are therefore significant health and socioeconomic consequences.
PitSTOP
A study examining the Prevalence and Risk of Anterior Pituitary Dysfunction following Traumatic Brain Injury
Minimal Unit Pricing Study (MUP)
Assessing the impact of the Minimum Unit Pricing
EHA - Epidemiological analysis for the Hereditary Angioedema Disease is an international, multicentre, epidemiological study that aims to explore the feasibility of a new Dried Blood Spot (DBS) filtercard-based screening algorithm and thereby the prevalence of the Hereditary Angioedema.
EHA Study
EHA - Epidemiological analysis for the Hereditary Angioedema Disease
To determine the association between high-sensitivity cardiac troponin concentration and obstructive coronary artery disease in patients presenting to the Emergency Department with suspected acute coronary syndrome and cardiac troponin concentration within the normal reference range using CTCA.
PRECISE-CTCA Trial
To determine the association between high-sensitivity cardiac troponin concentration and obstructive coronary artery disease in patients presenting to the Emergency Department with suspected acute coronary syndrome and cardiac troponin concentration within the normal reference range using CTCA.
Prospective multicentre observational study conducted over one calendar month in 2019, with the aim of describing the epidemiology of non-trauma related headache in adults presenting to emergency departments including investigations, treatments and outcome.
This will include adult patients presenting to the ED with non-trauma-related headache as their primary complaint.
HEAD Study
ETNA: Edinburgh Transient and Neurological attack: A Cohort Study
Patients frequently present with minor neurological symptoms where a diagnosis of transient ischaemic attack (TIA) or minor stroke is difficult to make positively or to exclude reasonably. For these patients, clinicians are uncertain whether they should: (a) reassure most patients that their symptoms are benign; (b) treat most patients with antiplatelet or other vascular prevention; or (c) stratify stroke risk further using clinical features or brain imaging.
This is important because clinical diagnosis is difficult. Mis-diagnosis is not infrequent and leads to harm from preventable recurrent stroke and costs to health systems from extra care and legal liabilities.
All ETNA participants will receive an MRI scan and the study aims to establish the feasibility and methods for a larger study of diagnostic utility of MR brain imaging and estimate the effects of MRI on clinician decision making.
This study has been recruiting in the Emergency Dept, inpatient wards and TIA clinics since August 2018. We aim to recruit 270 participants and have almost reached our target!