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Emerging disease crisis
Traumatic injury is responsible for a large and increasing proportion of the world’s burden of disease (Figure 1A) and is the 4th leading cause of death globally. Half of all trauma deaths are due to bleeding and most of these will occur within 6 hours from injury. Most often the consequence of road traffic collisions or interpersonal violence, this health problem has an ever increasing economic and societal impact in Europe with injuries: – accounting for 800,000 lives annually (i.e. 9% of all deaths). – being the leading cause of death among people 5–44 years old. – encompassing 20,000,000 (i.e. 14%) of all disability-adjusted life-years (DALYs).
TACTIC fig A TACTIC fig B  
Figure 1A
 – Global injury fatalities exceed that of HIV/AIDS, Tuberculosis and Malaria combined. B – Trauma patients classified as Coagulopathic (i.e. abnormal blood clotting) have a probability of mortality approaching 60% and are 20 times more likely to die than patients with normal coagulation. They are 30-fold more likely to require a blood transfusion and 50-fold more likely to receive a massive blood transfusion (i.e. 10U red blood cells) in the first 24hrs (n=600; classified using a composite of laboratory tests and unsupervised machine learning; Brohi et al unpublished).  
One quarter of all severely injured and haemodynamically shocked patients develop a clotting abnormality, termed early Trauma Induced Coagulopathy (TIC) within minutes of injury. This exacerbates life-threatening bleeding and is associated with greatly increased mortality and morbidity. Many more injured patients will go on to develop different types of coagulopathy at different times during the course of their treatment, either as a result of their body’s on-going response to trauma or as a consequence of their clinical care. Ultimately coagulopathic patients have increased blood transfusion requirements and have increased mortality (Figure 1B). Despite improvements in surgical techniques, resuscitation strategies and intensive care treatments, outcomes for critically injured patients remain poor with severe bleeding, brain injury, tissue damage and multiple organ failure linked to high mortality. Trauma is a healthcare field in which the uptake of new approaches can have a very immediate and significant effect on patient outcomes, both in terms of survival and quality of life. Even in high-resource trauma centres, one in three with massive haemorrhage will die [8]. Trauma research has previously been slow and inefficient, failing to make an impact upon the global burden of the disease and to capitalise on the exciting potential for injury research to enhance patient outcomes. Management in specialist trauma centres can produce significant improvement in outcome yet a key challenge is to identify which early interventions translate into improved outcomes and then provide consistent, timely access to those interventions for the population. TACTIC is a cohesive programme of fundamental and clinical research studies that will overcome this challenge and deliver enhancements in transfusion treatment based on our results that can reduce trauma fatalities by 10%, further saving more than 30,000 lives annually [9].  
Demand for personalised clinical care
Pan-European initiatives led by the partner centres have demonstrated that regional, multidisciplinary trauma service programmes enhance outcomes for critically injured patients. Although considered a preventable major cause of death, the current management of coagulopathic bleeding trauma patients is primarily based upon retrospective registry studies of survival and extrapolating the results of transfusion practice performed in the elective, non-acute surgical setting. Treatment is diverse comprises the empiric transfusion of red blood cells and clotting product supplements (e.g. plasma, fibrinogen, platelets, procoagulant concentrates) to patients, blind to the type and severity of TIC they may have – or indeed even if they do not have coagulopathy. Different products are administered to patients in different EC countries, without universally applicable evidence.  
The absence of rapid and validated tools for diagnosing TIC means that current treatment potentially incurs avoidable waste of precious resources, delay in time-critical treatment, longer-term complications and the inability to save life. TACTIC will compare current EC practice at the local specialist centre level, and deliver evidence-based clinical support for the diagnosis and delivery of personalised, targeted treatment of coagulopathic bleeding patients.   More information: http://tactic.dana6.dk/  
The TACTIC project is co-funded by the European Commission under the HEALTH-Contract No. F3-2013-602771