2023 HMRI Researcher of the Year, Professor Zsolt Balogh wants polytrauma recognised as a disease by the World Health Organization. It’s currently recognised in the category of acute injury, but if his work comes to fruition, it will be recognised as a disease.

Professor Zsolt Balogh is an international leader in surgical, trauma and musculoskeletal research, education and clinical care. He is the Discipline Head of Traumatology and Surgery at the School of Medicine and Public Health, University of Newcastle, the Director of Trauma at John Hunter Hospital and Hunter New England Local Health District. He also leads the Injury and Trauma Research Program at the Hunter Medical Research Institute. Professor Balogh is a busy practicing trauma and orthopaedic surgeon with a major interest and expertise in complex polytrauma patient management, traumatic shock resuscitation, postinjury multiple organ failure and pelvic and acetabulum fracture patients.

“It has all the aspects of a disease and yet it’s not treated as such,” says Professor Balogh.  

What is Polytruma

Polytrauma is what happens when someone suffers from massive transfer of kinetic energy, like what happens in a car crash, fall from height, or a pedestrian hit by car. There are obvious physical injuries but there are less obvious secondary implications like major inflammation of the entire body and failure of organs not even injured in the first place.  

“We know that people who have suffered polytrauma will have worse outcomes among the injured, in both the short-term and long-term. But it is underappreciated that they have a higher risk of heart disease, diabetes, cancer and other chronic degenerative diseases because they burn out their regenerative capability in the acute phase of polytrauma.  

“Overall their life expectancy is shortened. This is very alarming even without the life-long psychological consequences of polytrauma. To me, this is both scary and fascinating. Injury is imagined as an accident and acute problem, which may make it to the news. The ongoing chronic impact isn’t really recognised. 

“Every tissue has a certain hidden clock that dictates how long cells can reproduce and rejuvenate themselves, the battery life of this clock is shortened due to polytrauma. I am interested in trying to understand how to rejuvenate and reprogram injured organs so that I can increase the survival of salvageable injured cells and hopefully maintain their potential to reproduce long-term,” says Professor Balogh.  

As Head of Traumatology at Newcastle’s John Hunter Hospital, Professor Balogh manages around 1,500 severely injured patients each year. Up to 400 of these patients classify as polytrauma.

How kinetic energy leads to polytrauma

In 2021, Physiology and Medicine Nobel Prize winners David Julius and Ardem Patapoutian discovered the presence of cellular receptors for temperature and touch, leading to a deeper understanding of what is happening on a cellular level after a traumatic injury.

“We learnt recently that the kinetic energy transfer to the body that causes the deformation and pressure on the cells is what makes them dysfunctional.” said Professor Balogh.

“There are Piezo receptors in the cell membrane that detect pressure. When this happens, the receptors open up iron channels for calcium influx which then interfere with cellular functions like energy transformation, cell reproduction and disposal. This disruption speeds up the ageing process and causes inflammation in the body”.

Because of Professor Balogh, 92% of the most severely injured 500 patients coming through John Hunter Hospital ar enow surviving, However this means that there are now an additional 400 people a year in the Hunter alone that will experience polytrauma.

The impact of polytrauma

The hospitalisation of polytrauma patients is complicated by intense inflammation caused by their injuries and their essential treatment, which frequently shuts down the function of uninjured vital organs leading to multiple organ failure.

Survivors of polytrauma are at high risk of developing chronic diseases such as diabetes, heart disease, and cancer, and they have a shorter life expectancy.

There is no known treatment…yet

There is currently no Australian Government funding for polytrauma research

Professor Balogh has been working with the World Health Organization to have polytrauma included in the new version of the International Classification of Diseases for the past two years. The final committee meeting is imminent.

If polytrauma received recognition as a disease, it is hoped that governments might finally support it with the research funding it needs to find earlier, better treatments.